Association between transformational leadership, organizational commitments, and application of Total Quality Management (TQM) to employee performance in Sanglah General Hospital, Bali, Indonesia

Background: Employee performance results from work achieved by an employee in quality and quantity in carrying out tasks in accordance with the responsibilities given. Good employee performance increases hospital customer satisfaction. This study aims to determine the relationship between transformational leadership, organizational commitment, and the application of Total Quality Management (TQM) with employee performance at Sanglah Central General Hospital.

Methods: A cross-sectional study was conducted among 87 samples. Samples in each installation/unit that fulfilled inclusion criteria were selected using proportional random sampling. Data were analyzed using univariate, bivariate (chi-square), and multivariate (logistic regression) by SPSS version 20 for Windows.

Results: Most employees perceived good in transformational leadership (67.8%), good organization commitment (55.2%), good application of TQM (75.9%), and good employee's performance (65.5%). The bivariate analysis shows a significant association between transformational leadership (p=0.001), organization commitment (p=0.001), and application of TQM (p=0.010) with employees' performance in Sanglah General Hospital. However, according to the multivariate analysis, a statistically significant association variable is organizational commitment (OR=547.96; 95% CI=4.922-613.673; p=0.001).

Conclusion: Factors associated with the employee's performance in Sanglah Hospital are transformational leadership, organizational commitment, and TQM. Therefore, stakeholders in the hospital should consider the loyalty of employees in determining policies to improve service quality continuously.

Pengaruh puasa berselang terhadap berat badan pada mahasiswa Program Studi Pendidikan Dokter Fakultas Kedokteran Universitas Udayana

Background: Body weight is used as a measure of body mass in kilogram (kg). The way which is effective for weight loss is a lifestyle changes like diet and exercise. Besides low calorie diet, we can do intermittent fasting to prevent overweight and obesity.

Aim: This research aims to know the effect of intermittent fasting on body weight in young adult group.

Methods: This research uses pretest-posttest control group design which was conducted during Ramadhan fasting in 2017 in the Department of Physiology, Faculty of Medicine, Udayana University. The subject is divided into two groups, namely fasting group and unfasting group as many as 40 people, respectively. The data include weight before and after fasting.

Results: Normality test obtained both fasting groups with p=0.326 and unfasting one with p=0.317, so that both groups are homogenous. Paired-sample t test on the weight for the beginning and end of the fasting group obtained the value of p=0.000, whereas in unfasting group obtained 0.149.

Conclusion: Intermittent fasting affects early weight loss and final body weight on fasting group consequently. As for the unfasting group, it was obtained no significant distinction between initial weight compare with latest weight.

Latar belakang: Berat badan digunakan sebagai ukuran massa tubuh dalam kilogram (kg). Cara yang paling efektif untuk menurunkan berat badan adalah perubahan gaya hidup meliputi diet dan olahraga. Selain diet rendah kalori, cara untuk mencegah kelebihan berat badan dan obesitas adalah puasa berselang.

Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh puasa berselang terhadap berat badan pada kelompok dewasa muda.

Metode: Penelitian ini menggunakan pretest-posttest groups control design yang dilakukan saat puasa Ramadhan 2017 di bagian Fisiologi Fakultas Kedokteran Universitas Udayana. Subjek penelitian dibagi menjadi dua kelompok yaitu kelompok puasa dan kelompok tidak puasa yang masing-masing berjumlah 40 orang. Data yang diambil meliputi berat badan sebelum dan sesudah puasa.

Hasil: Hasil uji normalitas didapatkan untuk kelompok puasa dengan p=0.326 dan kelompok tidak puasa p=0.317 yang berarti kedua kelompok homogen. Pada uji t-test berpasangan untuk berat badan awal dan akhir pada kelompok puasa didapatkan nilai p=0.000, sedangkan pada kelompok tidak puasa didapatkan nilai p= 0.149.

Simpulan: Puasa berselang berpengaruh terhadap penurunan berat badan awal dan berat badan akhir pada kelompok puasa. Sedangkan bagi kelompok tidak puasa, tidak didapatkan perbedaan yang bermakna antara berat badan awal dengan berat badan akhir.

Relationship Between Procalcitonin Serum Level and Septic Patient Mortality in Dr. Saiful Anwar General Hospital, Malang

Background: Procalcitonin is more frequently analyzed for sepsis diagnosis. Procalcitonin shows a tendency to increase as sepsis worsens. However, published studies investigating the correlation between procalcitonin and mortality in an adult patient with sepsis in Indonesia were lacking. This research aims to know the relationship between procalcitonin and mortality in sepsis.

Methods: A prospective cohort study was conducted in Dr. Saiful Anwar Public General Hospital, Malang, Indonesia from March to November 2018. During the study period, patients diagnosed with sepsis according to JAMA Sepsis-3 were tested for procalcitonin using Cobas e411 ECLIA method. The demographic and mortality data were acquired from the patients’ medical record. The statistical analysis was done with SPSS v.23, ? = 0.05.

Results: From a total of 69 subjects, 43 did not survive (62.32%). The procalcitonin serum level is significantly higher in the non-survivors than the survivors (37.77 ng/mL vs. 3.07 ng/mL, p=0.016). The Spearman’s rank correlation test showed r=0.293 (p=0.015). Using a cutoff point of 2 ng/mL, the relative risk is 2.77 (0.950-8.078).

Pengaruh kadar haemoglobin dan hematokrit dengan insiden kegagalan arteriovenous fistula pada pasien gagal ginjal kronik stadium V

Chronic Kidney Disease (CKD) is a disease that requires important attention. Chronic kidney failure is mentioned as kidney damage that occurs more or equal to 3 months in the form of abnormal structural or functional damage from the kidney with or without a decrease in GFR. Management of chronic renal failure is hemodialysis. Hemodialysis performed on patients with chronic renal failure requires appropriate vascular access.

Method: This study involved 76 respondents with a cross-sectional observation design in patients with stage V chronic kidney disease in Sanglah Hospital Denpasar from January 2018 to December 2018 conducted by arteriovenous fistula, with an age range of 17 years to 65 years, who have undergone regular hemodialysis for more than 3 month and with complete medical records.

Result: From this study it was found, characteristics based on age ? 55 years were 40 respondents (52.6%) and age <55 were 36 respondents (47.4%). Characteristics based on gender obtained male data as many as 43 respondents (56.6%) and women as many as 33 respondents (43.4%). Characteristics based on BMI obtained a median value of 26. Characteristics based on BMI ? 26 Kg / m2 were 39 respondents (51.3%) and BMI <26 Kg / m2 were 37 respondents (48.7%). Characteristics based on INR ? 1.2 were 10 respondents (13.2%) and INR 0.9-1.1 were 66 respondents (86.8%). Characteristics based on DM disease obtained with DM disease data as many as 17 respondents (22.4%) and without DM disease as many as 59 respondents (77.6%). Patients with hemoglobin hemoglobin levels <9.9 gr / dl with non-patent AVF 47 (73.4%) and ? 9.9 gr / dl with non-patent AVF 17 (26.6%) while hemoglobin levels <9, 9 gr / dl with patent AVF of 3 (25%) and ? 9.9 gr / dl with patent AVF of 9 (75%) [PR=1,4; IK1,07-1,91; p=0,001].

Conclusion: Hemoglobin <9.9 associated with failure of AVF. Low hemoglobin is the most important risk factor for the occurrence of AVF failure in CRF patients. Hematocrit <29.18 related to AVF failure.

Gagal Ginjal Kronik (GGK) merupakan penyakit yang memerlukan perhatian penting. Gagal ginjal kronik disebutkan sebagai kerusakan ginjal yang terjadi lebih atau sama dengan 3 bulan baik berupa kerusakan struktur atau fungsi yang abnormal dari ginjal dengan atau tanpa penurunan GFR yang dilakukan kepada pasien GGK memerlukan akses vaskular yang tepat.

Metode: Penelitian ini melibatkan 76 responden dengan rancangan observasi crossectional pada pasien  gagal ginjal kronis stadium V di RSUP Sanglah Denpasar dari mulai bulan Januari 2018 sampai Desember 2018 yang dilakukan arteriovenous fistula, dengan rentang umur 17 tahun sampai 65 tahun, yang sudah menjalani hemodialisis regular lebih dari 3 bulan dan dengan catatan medis yang lengkap. 

Hasil: Karakteristik berdasarkan umur ? 55 tahun sebanyak 40 responden (52,6%) dan umur < 55 sebanyak 36 responden (47,4%). Karakteristik berdasarkan jenis kelamin didapatkan data laki-laki sebanyak 43 responden (56,6%) dan perempuan sebanyak 33 responden (43,4%). Karakteristik berdasarkan BMI didapatkan nilai median 26. Karakteristik berdasarkan BMI  ? 26 Kg/m2 sebanyak 39 responden (51,3%) dan BMI < 26 Kg/m2 sebanyak 37 responden (48,7%). Karakteristik berdasarkan INR  ? 1,2 sebanyak 10 responden (13,2%) dan INR 0,9-1,1 sebanyak 66 responden (86,8%). Karakteristik berdasarkan penyakit DM didapatkan data dengan penyakit DM sebanyak 17 responden (22,4%) dan tanpa penyakit DM sebanyak 59 responden (77,6%).  Pasien dengan kadar haemoglobin Haemoglobin < 9,9 gr/dl dengan AVF tidak paten sebanyak 47(73,4%) dan  ? 9,9 gr/dl dengan AVF tidak paten sebanyak 17(26,6%) sedangkan kadar haemoglobin < 9,9 gr/dl dengan AVF  paten sebanyak 3 (25%)  dan  ? 9,9 gr/dl dengan AVF  paten sebanyak 9 (75%) [PR=1,4; IK1,07-1,91; p=0,001].

Simpulan: Hemoglobin < 9,9 berhubungan dengan kegagalan AVF. Haemoglobin yang rendah menjadi faktor risiko yang paling berperan terhadap terjadinya kegagalan AVF pada pasien GGK..Hematokrit < 29,18 berhubungan dengan kegagalan AVF. 

Ekstrak buah makasar (Brucea Javanica (L) Mer.) meningkatkan kadar enzim Superoksida Dismustase (SOD) mencit (Mus musculus) Swiss Webster jantan yang diinduksi paraquat

Background: Aging is a biological process where one of the contributing factors is oxidative stress due to free radicals in the body. Paraquat is an example of free radicals that are often used by oil palm plantation farmers in Bengkulu, which can trigger the aging process by reducing the enzyme Superoxide Dismutase (SOD). The provision of fruit extract of Makassar (Brucea javanica (L) Mer) contains bioactive compounds that can function as antioxidants by increasing SOD levels in the body. This study aims to prove that the fruit extract can increase the levels of SOD of male Swiss Webster mice induced by paraquat.

Methods: In vivo experimental research with randomized pretest-posttest control group design was conducted on 14 Swiss Webster mice (Mus musculus) as research subjects. The research subjects were then divided into 2 groups, namely the control and the treatment group (20 mg/kgBW/day (P1) for 14 days). Data were analyzed using SPSS version 17 for Windows.

Results: The results showed that there was no significant increase in the mean of SOD levels either before (16.97±1.45 U/ml) or after (17.07±1.89 U/ml) treatment in the P0 group (p> 0.05). However, in the P1 group that was given paraquat induction coupled with Makassar fruit extract at a dose of 20 mg/kgBW/day for 14 days, it showed that there was a significant increase in the mean SOD levels from 17.18±1.69 U/ml to 67.56±3.65 U/ml (p <0.05).

Conclusion: Provision of Makasar fruit extract at a dose of 20 mg/kgBW/day for 14 days was found to significantly increase the mean SOD levels in Swiss Webster male mice induced by paraquat.

 

Latar Belakang: Penuaan adalah suatu proses biologi dimana salah satu faktor penyebabnya adalah stres oksidatif akibat radikal bebas yang terjadi di dalam tubuh. Paraquat merupakan salah satu contoh radikal bebas yang sering digunakan oleh petani perkebunan sawit di Bengkulu dimana dapat memicu proses penuaan melalui penurunan kadar enzim Superoksida Dismutase (SOD). Pemberian ekstrak buah makasar (Brucea javanica (L) Mer) mengandung senyawa bioaktif yang dapat berfungsi sebagai antioksidan dengan meningkatkan kadar SOD dalam tubuh. Penelitian ini bertujuan untuk membuktikan bahwa ekstrak buah makasar dapat meningkatkan kadar SOD mencit jantan swiss Webster yang diinduksi paraquat.

Metode: Penelitian eksperimental secara in vivo dengan rancangan randomized pretest-posttest control group design dilakukan terhadap 14 ekor mencit (Mus musculus) swiss Webster sebagai subjek penelitian. Subjek penelitian kemudian dibagi menjadi 2 kelompok, yaitu kelompok kontrol dan kelompok perlakuan (20 mg/kgBB/hari (P1) selama 14 hari). Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian menunjukan bahwa tidak terdapat peningkatan bermakna rerata kadar SOD baik sebelum (16,97±1,45 U/ml) atau setelah (17,07±1,89 U/ml) perlakuan pada kelompok P0 (p>0,05). Akan tetapi, pada kelompok P1 yang diberikan induksi paraquat ditambah dengan ekstrak buah makasar dengan dosis 20 mg/kgBB/hari selama 14 hari menujukkan terdapat peningkatan secara bermakna rerata kadar SOD dari 17,18±1,69 U/ml menjadi 67,56±3,65 U/ml (p<0,05).

Kesimpulan: Pemberian ekstrak buah makasar dosis 20 mg/kgBB/hari selama 14 hari diketahui dapat meningkatkan rerata kadar SOD secara bermakna pada mencit jantan swiss Webster yang diinduksi paraquat.

Hubungan derajat keparahan preeklamsia dengan kejadian asfiksia neonatorum di Rumah Sakit Umum Negara periode Januari 2019 - Januari 2020

Background: Preeclampsia is one of complication in pregnancy and the causal of maternal morbidity and mortality. There is an impairment of blood flow to placenta vascularization which lead to tissue hypoxia and increase the chance to develop asphyxia neonatorum. The aim of this study is to know the correlation between severity of preeclampsia and asphyxia neonatorum in Negara General Hospital on January 2019-January 2020.

Methods: The design of this study was observational analytic cross-sectional. Woman who was diagnosed with preeclampsia and delivered in Negara General Hospital, Jembrana between January 2019-January 2019 were included by total sampling. Data, such as maternal age, parity, mode of delivery, severity of preeclampsia and asphyxia neonatorum, were collected from medical record. Then, data was analyzed bivariate using chi-square test and prevalence ratio (PR) analysis was conducted. The value of p<0,05 was considered significant.

Results: As many as 170 women with preeclampsia were recruited in the study. The prevalence of birth asphyxia was 71,2% in this study. Majority of women were 20-35 years old (67,1%), parity 2-3 (50,6%), had assisted-delivery (74,7%) and severe preeclampsia (72,9%). A bivariate analysis showed the prevalence of asphyxia neonatorum was significantly higher in assisted-delivery (PR=2,541, p=0,036; 95% CI=1,044-6,188) and severe preeclampsia (PR=2,346, p=0,045; 95% CI=1,044-5,486).

Conclusion: Mode of delivery and severity of preeclampsia is associated with asphyxia neonatorum. Early identification and proper antepartum management were essential to prevent asphyxia neonatorum in mother with risk factors.

 

 

Latar Belakang: Preeklampsia adalah salah satu komplikasi kehamilan dan penyebab morbiditas dan mortalitas maternal. Kondisi ini menyebabkan gangguan aliran darah ke vaskularisasi plasenta sehingga dapat menimbulkan hipoksia jaringan dan berpotensi menyebabkan asfiksia neonatorum. Penelitian ini bertujuan untuk mengetahui hubungan antara derajat keparahan preeklampsia dan kejadian asfiksia neonatorum di Rumah Sakit Umum (RSU) Negara.

Metode: Penelitian ini menggunakan rancangan analitik observasional desain potong-lintang. Sampel penelitian adalah wanita yang terdiagnosis dengan preeklampsia dan menjalani persalinan di RSU Negara, Jembrana dalam kurun waktu Januari 2019 – Januari 2020 yang dikumpulkan secara total sampling. Data berupa usia maternal, paritas, metode persalinan, derajat preeklampsia, dan kejadian asfiksia neonatorum didapatkan dari rekam medis. Data kemudian dianalisis secara bivariat dengan uji chi-square dan dilakukan analisis prevalence ratio (PR). Hubungan dikatakan signifikan apabila diperoleh nilai p<0,05.

Hasil: Penelitian ini mengikutsertakan 170 pasien yang memenuhi kriteria inklusi dan eksklusi. Sebanyak 71,2% kejadian asfiksia neonatorum tercatat dalam penelitian ini. Mayoritas ibu berusia 20-35 tahun (67,1%), memiliki paritas 2-3, melakukan persalinan dengan tindakan (74,7%), dan mengalami preeklampsia berat (72,9%). Berdasarkan hasil uji bivariat, prevalensi kejadian asfiksia neonatorum lebih tinggi pada persalinan dengan tindakan (PR=2,541, p=0,036; Confidence interval (CI) 95% 1,044-6,188) dan preeklampsia berat (PR=2,346, p=0,045; CI 95% 1,044-5,486).

Simpulan: Metode persalinan dan derajat preeklampsia berhubungan dengan kejadian asfiksia. Deteksi dini dan penanganan anterpartum yang tepat dapat membantu mencegah kejadian asfiksia neonatorum pada ibu yang berisiko.

Hubungan faktor bakteriuria dan leukosituria dengan kejadian persalinan Preterm Premature Rupture of Membrane (PPROM) dan Premature Rupture of Membrane (PROM) di RSUD Mangusada, Badung tahun 2018-2019

Background: Preterm labor is one of the most contributors to morbidity and mortality in perinatal and neonatal. Several factors may cause preterm labor with infection as pathophysiology, including urinary tract infection (UTI), to initiate inflammation cascade. This study aims to determine the relationship between bacteriuria and leukocytic factors with the incidence of preterm premature rupture of membrane (PPROM) and premature rupture of membrane (PROM) delivery at Mangusada Hospital, Badung in 2018-2019.

Methods: A cross-sectional observational research toward 92 expectant within PPROM and 92 expectant within PROM was done to know the relation between leukocyturia and bacteriuria with the risk of PPROM and PROM. The research variable involves secondary data from urinalysis of leukocyturia and bacteriuria by flowcytometry Sysmex UX-2000 taken from the patient’s registry at maternity room Mangusada Hospital, Badung in 2018-2019. Data were analyzed using SPSS version 17 for Windows.

Results: The study results show leukocyturia in PPROM is about 93.42% and 6.5% in PROM, while 71.67% bacteriuria within PPROM and 28.33% within PROM. There’s no significant relationship between bacteriuria result in PPROM and PROM (p=0.247), but there’s considerable relation between leukocyturia within PPROM and PROM (p=0.000).

Conclusion: It can be concluded that there’s a significant relationship between leukocyturia within PPROM and PROM.

 

 

Latar Belakang: Persalinan preterm merupakan salah satu penyumbang besar morbiditas dan mortalitas perinatal dan neonatal. Berbagai faktor dapat menyebabkan persalinan preterm dengan mekanisme patofisiologi terutama infeksi, salah satunya infeksi saluran kemih (ISK), yang dapat menginisiasi kaskade inflamasi. Penelitian ini bertujuan untuk mengetahui hubungan faktor bakteriuria dan leukosituria dengan kejadian persalinan Preterm Premature Rupture of Membrane (PPROM) DAN Premature Rupture of Membrane (PROM) di RSUD Mangusada, Badung tahun 2018-2019

Metode: Penelitian observational cross-sectional terhadap 92 ibu hamil bersalin dengan PPROM dan 92 ibu dengan PROM dilakukan untuk mengetahui hubungan antara bakteriuria dan leukosituria dengan risiko terjadinya persalinan PPROM dan PROM. Variabel penelitian berupa data sekunder hasil urinanalisa flowcytometry Sysmex UX-2000 (leukosituria dan bakteriuria) diambil dari register pasien di ruang bersalin Rumah Sakit Daerah Mangusada Badung tahun 2018-2019. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian menunjukkan leukosituria pada PPROM sebanyak 93.42% dan 6.5% pada PROM, sedangkan bakteriuria sebanyak 71.67% pada PPROM dan 28.33% pada PROM. Tidak ada hubungan yang bermakna antara kejadian bakteriuria dengan persalinan PPROM dan PROM (p=0,247). Namun, ditemukan hubungan yang bermakna antara leukosituria dengan persalinan PPROM dan PROM (p=0,000).

Kesimpulan: Dapat disimpulkan terdapat hubungan signifikan antara leukosituria dengan persalinan PPROM dan PROM.

Dermatitis atopi pada bayi usia 0-12 bulan kelahiran RSUP Sanglah Denpasar dengan riwayat atopi keluarga antara bulan Desember 2015-Januari 2016

Atopy disease is a genetic predisposition to develop any allergies in person. The example of atopic disease is atopic dermatitis, a chronic residual skin disorder that often occurs in infancy to children with itching, redness, and vesicles on the skin as its symptoms. The causes of atopic dermatitis are a family history of atopy, age, and environmental factors. If the parent or the family has a history of atopy, there will be a chance for the child to has dermatitis atopy in the next time.

Aim: This study aims to determine the role of family history in atopy dermatitis’s incidence in infants aged 0-12 months.

Method: Total sampling method used in the study obtained 39 samples with a family history of atopy. Anamnesis was conducted to determine the history of atopy which is owned by the samples.

Result: It showed that 22 samples had atopy dermatitis and 17 samples didn’t have atopy dermatitis.

Conclusion: The results of this study indicated that family history of atopy has a role in atopy dermatitis’s incidence in infants aged 0-12 months.

Penyakit atopi merupakan salah satu penyakit genetik yang mengembangkan suatu alergi pada individu. Contoh dari penyakit atopi adalah dermatitis atopi, yaitu penyakit kulit kronik residif yang umumnya terjadi saat usia bayi hingga anak-anak dengan gejala berupa rasa gatal, kemerahan, serta terbentuknya vesikel pada kulit. Pencetus munculnya dermatitis atopi adalah faktor riwayat atopi pada keluarga, faktor usia, dan faktor lingkungan. Apabila orang tua atau keluarga memiliki riwayat atopi, maka semakin besar kemungkinan untuk anak mengalami dermatitis atopi dikemudian hari.

Tujuan: Penelitian ini bertujuan untuk mengetahui peran riwayat atopi yang dimiliki keluarga terhadap kejadian dermatitis atopi pada bayi usia 0-12 bulan.

Metode: Dari total sampling diperoleh 39 sampel dengan riwayat atopi. Anamesis dilakukan untuk mengetahui riwayat atopi yang dimiliki sampel.

Hasil: Hasil anamnesis mendapatkan 22 sampel mengalami dermatitis atopi dan 17 sampel tidak mengalami dermatitis atopi.

Simpulan: Riwayat atopi keluarga memiliki peran terhadap kejadian dermatitis atopi pada bayi usia 0-12 bulan.

Karakteristik penderita tuberkulosis paru di Poli Paru RSUP Sanglah Denpasar pada bulan Januari 2016-Juli 2017

Background: Tuberculosis (TB) is a global infectious disease was ranked at the second position caused died after HIV. This disease was caused by Mycobacterium tuberculosis that was attacked pulmonary organ or extrapulmonary organ. One of the countries that has a high incidence of tuberculosis is Indonesia. Indonesia was ranked at  the second position as the country with the most top tuberculosis cases in the world after India.

Objective: This research was aimed to know the characteristic of patients with pulmonary tuberculosis in Pulmonary Poly of RSUP Sanglah.

Methods: This research was a observational descriptive study with cross-sectional approach. The subjects were 43 patients diagnosed with pulmonary tuberculosis and did the treatment in Pulmonary Poly of RSUP Sanglah from January 1, 2016 until July 31, 2017. This research is using primary data from the interview, measurement, and direct observation.

Results: The results showed patients with pulmonary tuberculosis was 88.4% in productive age group; 69.8% men; educational background of subjects was 39.5% senior high school; 30.2% private employee; Socioeconomic level of 65.1% subjects was low category; 39.5%, not an active smoker; 60.5% subjects had TB contact history; 81.4% HIV negative; 95.3% subjects didn’t have DM history; 67.4% of subjects had normal body mass index; 67.4% of subjects had qualify of ventilation (large ventilation ?10%); 67.4% subjects didn’t have qualify of house humidity (humidity <40% or >70%); 55.8% subjects didn’t have qualify of house lighting (lighting <60 lux or >300 lux); 81.4% subjects had house wall which is waterproof;  all of the subjects had house floor which is waterproof.

Latar Belakang: Tuberkulosis (TB) merupakan penyakit infeksi global yang menduduki posisi kedua penyebab kematian setelah HIV. Penyakit ini disebabkan oleh bakteri patogen Mycobacterium tuberculosis yang menyerang organ paru atau ekstra paru seseorang. Salah satu negara yang memiliki angka kejadian tuberkulosis yang cukup tinggi adalah Indonesia. Indonesia menduduki posisi kedua sebagai negara dengan kasus TB tertinggi di dunia setelah India.

Tujuan: Penelitian ini bertujuan untuk mengetahui karakteristik penderita tuberkulosis paru di Poli Paru RSUP Sanglah.

Metode: Penelitian ini merupakan penelitian deskriptif observasional dengan rancangan penelitian cross sectional. Subjek penelitian adalah 43 pasien yang terdiagnosis menderita tuberkulosis paru dan melakukan pengobatan di Poli Paru RSUP Sanglah pada rentang waktu 1 Januari 2016 s.d. 31 Juli 2017. Data penelitian adalah data primer yang diperoleh dari wawancara, pengukuran, dan observasi langsung.

Hasil: Hasil penelitian menunjukkan bahwa pasien TB paru terbanyak terdiri dari 88,4% memiliki usia produktif; 69,8% jenis kelamin laki-laki; 39,5% memiliki tingkat pendidikan SMA; 30,2% pegawai swasta; 65,1% berstatus sosial ekonomi kategori rendah; 39,5% bukan perokok aktif; 60,5% memiliki riwayat kontak TB; 81,4% HIV negatif; 95,3% tidak memiliki riwayat diabetes melitus; 41,8% memiliki indeks massa tubuh normal; 67,4% memiliki ventilasi rumah yang memenuhi syarat (luas ventilasi ?10%); 67,4% memiliki kelembaban rumah yang tidak memenuhi syarat (kelembaban <40% atau >70%); 55,8% memiliki pencahayaan rumah yang tidak memenuhi syarat (pencahayaan <60 lux atau >300 lux); 81,4% memiliki dinding rumah kedap air; dan seluruh pasien memiliki jenis lantai kedap air.

Karakteristik pasien gangguan bipolar yang dirawat di RSUP Sanglah Denpasar periode April 2016 – Maret 2017

Background: Bipolar disorder is a brain disorder that changes the mood, though, energy and behavior. These abnormalities are implicated by manic, hypomanic, depression and mixed episodes. The incidence of bipolar disorder is not too high, ranging from 2% -4%. However, the incidence of bipolar disorder is more prolonged and more increase.

Aim: This study aims to determine the characteristics of bipolar disorder treated in RSUP Sanglah Denpasar in the period April 2016 - March 2017.

Method: This study is a descriptive retrospective design which is set at the General Hospital (RSUP) Sanglah Denpasar. Data obtained in the form of secondary data of patient's medical record on period April 2016 - March 2017. Data were analyzed by using SPSS program.

Result and Conclusion: Of the 15 patients, the average age of the patient is 31-40 years (46.7%) with the first onset suffered on average 31-40 years old (40%), the most female (66.7% ), senior high school education (86.6%), unmarried marital status (53.3%), private employment (66.7%), bipolar type affective disorder bipolar episode now manic with psychotic symptoms (60%), none family history (80%), stressor of work problems (66.7%) with comorbid psychiatry (6.7%) and some with non-psychiatric comorbid (6.7%), substance abuse (26.7%), and most pharmacological therapy with anticonvulsant antipsychotic combination (20%) and non-pharmacological one by suggestive communication (40%) as well.

Gangguan bipolar adalah  kelainan otak yang ditandai dengan perubahan  mood, pemikiran, energi dan tingkah  laku. Kelainan ini ditandai dengan episode  manik, hipomanik, depresi dan campuran. Dapat dikatakan insiden gangguan bipolar tidak tinggi, berkisar 2%-4%. Namun, angka kejadian gangguan bipolar terus meningkat dari tahun ke tahun.

Tujuan: Untuk mengetahui karakteristik pasien gangguan bipolar yang dirawat di RSUP Sanglah Denpasar periode April 2016 – Maret 2017.

Metode: Penelitian ini berupa desain deskritif restrospektif yang dilakukan di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar. Data yang diperoleh berupa data sekunder rekam medis pasien periode April 2016 – Maret 2017. Data dianalisis dengan menggunakan program SPSS.

Hasil dan Simpulan: Dari 15 pasien, rata-rata berusia 31- 40 tahun (46,7%) dengan onset pertama kali menenderita rata-rata berusia 31-40 tahun (40%), jenis kelamin terbanyak adalah perempuan (66,7%), pendidikan terakhir SMA (86,6%), status pernikahan belum menikah (53,3%), pekerjaan swasta (66,7%), tipe bipolar gangguan afektif bipolar episode kini manik dengan gejala psikotik (60%), tidak ada riwayat keluarga (80%), stressor masalah pekerjaan (66,7%) dengan komorbid psikiatri (6,7%) lalu sebagian dengan komorbid non psikiatri (6,7), penyalahgunaan zat (26,7%), dan terapi farmakologi terbanyak dengan kombinasi antipsikotik antikonvulsan (20%) serta terapi non farmakologi dengan pemberian komunikasi informasi edukasi (40%).  

Perbandingan outcome penanganan pembedahan dan tanpa pembedahan pada fraktur radius distal di RSUP Sanglah periode April 2016-Agustus 2017

Background: Fracture of the distal radius is one of the most common fractures of the wrist. The incidence of fracture of the distal radius increases in each year. Management on the fracture of the distal radius can be grouped into two ie surgery and without surgery.

Aim: This study aims to determine the comparison of successful treatment between fracture of distal radius surgically and without surgery.

Method: This research used descriptive cross-sectional approach which is conducted at Sanglah General Hospital (RSUP) Denpasar. Data obtained was secondary data in the form of patient's medical record from April 2016 - August 2017 as well as primary data from patient interview. Data were analyzed using SPSS program.

Result: This study indicated that the most involved gender was men classified as adult (25-59 years). The incidence of most fracture of distal radius was caused by traffic accidents. It also obtained that there were no different outcomes between surgical and non-surgical therapy in patients with fracture of distal radius.

Conclusion: The comparison of surgical and non-surgical outcome at distal radius do not show significant differences statistically.

Fraktur radius distal adalah salah satu dari macam fraktur yang biasa terjadi pada pergelangan tangan. Angka kejadian fraktur radius distal meningkat di setiap tahunnya. Penatalaksanaan pada fraktur radius distal dapat dikelompokan menjadi dua yaitu pembedahan dan tanpa pembedahan.

Tujuan: Tujuan penelitian ini yaitu untuk mengetahui perbandingan keberhasilan terapi penanganan fraktur radius distal dengan pembedahan dan tanpa pembedahan.

Metode: Penelitian ini menggunakan metode penelitian deskriptif dengan pendekatan cross-sectional yang dilakukan di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar. Data yang diperoleh berupa data sekunder rekam medis pasien periode April 2016 – Agustus 2017 dan data primer dari wawancara pasien. Data dianalisis dengan menggunakan program SPSS.

Hasil: Penelitian ini menunjukkan bahwa jenis kelamin terbanyak yaitu pada laki-laki tergolong dewasa (25-59 tahun). Insiden fraktur radius distal terbanyak disebabkan oleh kecelakaan lalulintas. Penelitian ini juga mendapatkan hasil tidak terdapat perbedaan hasil outcome terapi pembedahan dan tanpa pembedahan pada pasien fraktur radius distal.

Kesimpulan: Perbandingan outcome penanganan pembedahan dan tanpa pembedahan pada fraktur radius distal tidak menunjukan perbedaan yang signifikan secara statistic.

Profil efek samping minor pada penggunaan OAT Kategori I pada pasien tuberkulosis paru di Poliklinik Paru RSUP Sanglah Oktober 2017 – Februari 2018

Background: Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. Indonesia is one of the countries with a high incidence of tuberculosis. Indonesia adopted DOTS as TB control with the use of OAT. Long-term treatment with OAT can cause mild or severe side effects.

Aim: This research aimed to determine the minor side effects profile of ATT category I in patients with pulmonary tuberculosis in Pulmonary Poly of RSUP Sanglah.

Methods: This research was a retrospective descriptive study with a cross-sectional approach. The subjects were 35 patients diagnosed with pulmonary tuberculosis and did treatment in Pulmonary Poly of RSUP Sanglah from October 1, 2017, until January 31, 2018. This research is using primary data the questionnaire that has been validated and then adopted by the authors and secondary data using medical records obtained at Pulmonary Poly of RSUP Sanglah.

Results and Conclusion: Patients with pulmonary tuberculosis was 94.3% experience sweat or urine in orange; 54.3% experienced nausea with or without vomiting, and 48.6% experienced no appetite. Adults experienced 3 to 4 minor side effects.

Latar Belakang: Tuberkulosis (TB) merupakan penyakit yang disebabkan oleh bakteri Mycobacterium tuberculosis. Salah satu negara yang memiliki angka kejadian tuberkulosis yang cukup tinggi adalah Indonesia. Indonesia mengadopsi DOTS sebagai penanggulangan TB dengan penggunaan OAT. Pengobatan jangka panjang dengan OAT dapat menimbulkan efek samping yang ringan ataupun berat.

Tujuan: Penelitian ini bertujuan untuk mengetahui profil efek samping minor penggunaan OAT kategori 1 pada pasien TB paru di Poliklinik Paru RSUP Sanglah.

Metode: Penelitian ini merupakan penelitian deskriptif retrospektif dengan rancangan penelitian cross sectional. Subjek penelitian adalah 35 pasien yang terdiagnosis menderita tuberkulosis paru dan melakukan pengobatan di Poli Paru RSUP Sanglah pada rentang waktu 1 Juli 2017 s.d. 31 Januari 2018. Data penelitian adalah data primer yang diperoleh dari kuisioner yang sudah tervalidasi dan kemudian diadaptasi oleh penulis dan data sekunder yang menggunkan Rekam Medis yang diperoleh di Poliklinik Paru RSUP Sanglah.

Hasil dan Kesimpulan: Hasil penelitian menunjukkan bahwa pasien TB paru mengalami keringat atau urin berwarna oranye (94,3%), mual dengan atau tanpa disertai muntah (54,3%), dan mengalami tidak nafsu makan (48,6%). Lalu responden kategori umur dewasa mengalami 3 sampai 4 efek samping minor.

Skor Patient Rated Wrist Examination (PRWE) dan Radius Union Scoring System (RUSS) lebih baik dengan pemberian Platelet Rich Plasma pada kasus fraktur distal radius dengan terapi konservatif

Introduction: Platelet Rich Plasma (PRP) is one of the supporting therapies that can increase the rate of tissue regeneration. In orthopedics, PRP is generally considered a therapy to accelerate bone regeneration, especially when combined with bone allografts. This study was conducted to determine whether the administration of platelet rich plasma (PRP) in conservative therapy of distal radius fractures resulted in a functional outcome (Patient Related Wrist Examination / PRWE score) and increased callus formation (Radius Union Scoring System / RUSS score) was better when compared to conservative therapy without PRP administration.

Methods: A total of 22 patients with distal radius fracture were divided into two groups, the intervention group who underwent closed reduction, immobilization with short arm cast and PRP injection at the fracture site, and the control group who received a placebo injection of 0.9% NaCl. After 8 weeks, the evaluation was carried out with the PRWE form and radiologic examination to assess RUSS. The research data were then analyzed to determine the difference in mean scores between groups.

Results: The mean PRWE score was lower in the conservative + PRP treatment group (73.18 ± 5.96) than in the control group (79.55 ± 3.30), p value = 0.007. In addition, the mean RUSS score was higher in the conservative + PRP treatment group (5.27 ± 1.10) than in the control group (4.00 ± 1.18),  p value = 0.017.

Conclusion: Administration of PRP in conservative therapy of distal radius fractures resulted in a lower PRWE score and a higher RUSS score at 8 weeks. It can be used as a basis for administering PRP in adjunct therapy to conservative therapy of distal radius fractures.

Pendahuluan: Platelet Rich Plasma (PRP) merupakan salah satu terapi penunjang yang dapat meningkatkan kecepatan regenerasi jaringan. Dalam bidang orthopaedi, PRP umumnya dianggap sebagai terapi untuk mempercepat regenerasi tulang, terutama ketika dikombinasikan dengan allografts tulang. Penelitian ini dilakukan untuk menentukan apakah pemberian platelet rich plasma (PRP) pada terapi konservatif fraktur distal radius menghasilkan luaran fungsional (skor Patient Related Wrist Examination / PRWE) dan peningkatan pembentukan kalus (skor Radius Union Scoring System / RUSS) yang lebih baik apabila dibandingkan dengan terapi konservaif tanpa pemberian PRP.

Metode:  Sebanyak total 22 pasien dengan fraktur distal radius dibagi ke dalam dua kelompok, yakni kelompok intervensi yang menjalani reduksi tertutup, imobilisasi dengan short arm cast dan injeksi PRP di lokasi fraktur, serta kelompok kontrol yang mendapat injeksi plasebo berupa NaCl 0,9%. Setelah 8 minggu, evaluasi dilakukan dengan formulir PRWE dan pemeriksaan radiologik untuk menilai RUSS. Data penelitian kemudian dianalisis untuk mengetahui perbedaan rerata skor antar kelompok.

Hasil: Didapatkan rerata skor PRWE yang lebih rendah pada kelompok perlakuan konservatif + PRP (73,18 ± 5,96) dibanding pada kelompok kontrol (79,55 ± 3,30) dengan nilai p < 0,05. Selain itu, didapatkan pula rerata skor RUSS yang lebih tinggi pada kelompok perlakuan konservatif + PRP (5,27 ± 1,10) dibanding pada kelompok kontrol (4,00 ± 1,18) dengan nilai p < 0,05.

Simpulan: Pemberian PRP pada terapi konservatif fraktur distal radius menghasilkan skor PRWE yang lebih rendah dan skor RUSS yang lebih tinggi dalam waktu 8 minggu. Hal ini dapat digunakan sebagai dasar pemberian PRP dalam terapi tambahan pada terapi konservatif fraktur distal radius.

Hubungan antara Tumor Infiltrating Lymphocytes (TIL), ekspresi Programmed Death-Ligan 1 (PD-L1) pada sel tumor dan TIL dengan kedalaman invasi pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah, Bali, Indonesia

Background: Urotelial carcinoma is one of carcinoma with increasing morbidity and mortality. The depth of invasion is one of risk factors that influence recurrence and survival rate in urotelial carcinoma. Patient with deeper invasion has poorer prognosis in recurrence and survival rate. Generally, carcinoma have microenvironment such as tumor infiltrating lymphocytes (TIL) to eliminate the tumor cells, in proliferative area. Cancer cells can avoid host immunity through PD-1/PD-L1 pathway. This study aimed to determine the association between TIL and PD-L1 expression with the depth of invasion of urotelial carcinoma.

Methods: This study was a cross sectional analytic study with 37 samples size. The samples were taken from paraffin block of patients with urotelial bladder carcinoma non-specific type, that has performed resection and histopathological examination at Anatomical Pathology Laboratory Sanglah Hospital Denpasar, from January 1^st, 2015 to December 31^th, 2019. Rediagnosis was carried out to assess the histopathological diagnosis, TIL and depth of invasion. Then PD-L1 immunohistochemistry was performed. Data were analyzed by Chi-Square test with p<0.05. Data were analyzed using SPSS version 20 for Windows.

Results: In this study on bladder urothelial carcinoma non-specific type at Sanglah Hospital Denpasar, we found there is no association between TIL and the depth of invasion (p=0.471). There is association between PD-L1 expression in tumor cells with the depth of invasion (p=0.006), OR 7.04 (CI 95% =1.64-30.20). There is association between PD-L1 expression in TIL with the depth of invasion (p=0.001), OR 13.2 (CI 95% = 2.62-66.43).

Conclusion: There is association between PD-L1 expression in tumor cells an PD-L1 expresion in TIL with the depth of invasion. Positive expression of PD-L1 in tumor cells and TIL are more likely to become advance invasion. Tumor Infiltrating Lymphocytes (TIL) and PD-L1 expression on TIL can be used as predictive factors for the depth of invasion in urotelial carcinoma.

Latar Belakang: Karsinoma urotelial merupakan salah satu karsinoma dengan morbiditas dan mortalitas yang terus meningkat. Salah satu faktor risiko yang mempengaruhi rekurensi dan survival rate pada karsinoma urotelial adalah kedalaman invasi. Invasi yang lebih dalam memiliki prognosis yang lebih buruk. Karsinoma umumnya disertai lingkungan mikro antara lain tumor infiltrating lymphocytes (TIL) yang berfungsi untuk mengeliminasi tumor. Sel kanker memiliki kemampuan untuk menghindari imun host antara lain melalui ikatan PD-1 dengan PD-L1. Tujuan dari penelitian ini untuk mengetahui hubungan antara TIL dan ekspresi PD-L1 dengan kedalaman invasi pada karsinoma urotelial.

Metode: Penelitian ini merupakan studi analitik potong lintang dengan besar sampel adalah 37, yang berasal dari blok parafin penderita karsinoma urotelial kandung kemih tipe tidak spesifik yang diperiksa histopatologi di Laboratorium Patologi Anatomi RSUP Sanglah Denpasar dari 1 Januari 2015 sampai 31 Desember 2019. Rediagnosis preparat dilakukan untuk menilai diagnosis histopatologi,  TIL serta kedalaman invasi. Kemudian dilakukan pulasan imunohistokimia PD-L1. Data dianalisis dengan uji Chi-Square dengan nilai p<0,05. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Hasil penelitian ini menunjukkan bahwa pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah Denpasar, tidak terdapat hubungan yang signifikan antara TIL dengan kedalaman invasi (p=0,471). Terdapat hubungan yang signifikan antara ekspresi PD-L1 pada sel tumor dengan kedalaman invasi (p=0,006) dengan OR 7,04 (IK 95% =1,64-30,20), antara ekspresi PD-L1 pada TIL dengan kedalaman invasi (p=0,001) dengan OR 13,20 (IK 95% = 2,62-66,43).

Kesimpulan: Terdapat hubungan antara ekspresi  PD-L1 pada sel tumor dan pada TIL dengan kedalaman invasi pada karsinoma urotelial kandung kemih tipe tidak spesifik di RSUP Sanglah Denpasar. Ekspresi positif PD-L1 pada sel tumor dan pada TIL memiliki kemungkinan lebih besar untuk menjadi invasi lanjut.

Relationship between cardiovascular fitness and academic achievement among medical students of Udayana University in batch 2018

Background: Physical fitness especially cardiovascular fitness is one of the important factors in medical students’ academic achievement which has been neglected by majority of the students. Through cardiovascular fitness the stress level could be reduced which will eventually help the students to achieve better academic results.

Aim: This study aims to determine the relationship between the cardiovascular fitness and academic achievements by medical students of Medical Faculty of Universitas Udayana from batch 2018.

Method: An experimental survey method has been used identify the relationship between cardiovascular fitness level and academic achievement. Respondents who attended this study were 79 students from the batch 2018. The cardiovascular fitness level will be measured by Fartlek training which is conducted in medical faculty campus parking area. The students’ academic achievement will be measured through their 1^st biomedic exam results. Then, the pulse rate collected from the Fartlek training and the academic achievement from exam was compared to identify the relationship the cardiovascular fitness and academic achievement.

Results: The data was not normally distributed from the normality test. Spearman’s rho test shows that the data is not significant with the (p = -0.056).

Conclusion: There was no significant relationship between the level of cardiovascular fitness and the academic achievement of the medical students.

Kadar low density lipoprotein (LDL) tinggi berhubungan dengan peningkatan severitas sindrom koroner akut

Background: Acute coronary syndrome (ACS) is a collection of symptoms that caused by disruption of coronary arteries so that decreasing the oxygen levels to the heart muscle (myocardium). Low-density Lipoprotein (LDL) is a lipid-carrying lipoprotein with the strongest predisposing factor compared to other cholesterol in supporting the formation of atheroma plaques in blood vessels that flow through the heart muscle in patients with acute coronary syndrome.

Methods: This study is an analytic cross-sectional observational study aimed at seeing whether there is a relationship between levels of Low Density Lipoprotein (LDL) with an increase in severity of acute coronary syndrome. The population of this study were patients with a diagnosis of acute coronary syndrome at Sanglah Hospital Denpasar from July 2018 – January 2019. The relationship between LDL levels and severity of acute coronary syndrome was analyzed using Spearman correlation test and multivariate analysis in the form of discriminant analysis to analyze the relationship of LDL levels with severity of acute coronary syndrome compared with other risk factors as confounding variables.

Results: Spearman correlation test showed that there was a significant positive relationship between LDL levels and severity of acute coronary syndrome with p = 0.01 and Spearman’s correlation coefficient of +0.365. The result of the study of discriminant analysis test also showed that there was a significant positive relationship between LDL levels and severity of acute coronary syndrome after being analyzed along with confounding variables with a value of p = 0.004.

Conclusions: There was a significant positive relationship between LDL levels and severity of acute coronary syndrome at RSUP Sanglah

Latar Belakang: Sindrom koroner akut merupakan suatu sekumpulan gejala yang disebabkan adanya gangguan pada arteri koronaria sehingga kadar oksigen menuju otot jantung (miokardium) mengalami penurunan. Low-Density Lipoprotein (LDL) merupakan lipoprotein pengangkut lipid dengan faktor predisposisi terkuat dibandingkan kolesterol lain dalam mendukung pembentukan plak ateroma pada pembuluh darah yang mengaliri otot jantung pada penderita sindrom koroner akut. 

Metode: Penelitian ini bersifat observasional cross-sectional analitik yang bertujuan untuk melihat apakah terdapat hubungan antara kadar Low Density Lipoprotein (LDL) dengan peningkatan severitas sindrom koroner akut.  Populasi dari penelitian ini merupakan pasien dengan diagnosis sindrom koroner akut di RSUP Sanglah Denpasar pada Juli 2018 – Januari 2019. Hubungan antara kadar LDL dengan severitas sindrom koroner akut dianalisis menggunakan uji korelasi Spearman serta analisis multivariat berupa uji analisis diskriminan untuk menganalisis hubungan kadar LDL dengan severitas sindrom koroner akut dibandingkan dengan faktor resiko lain sebagai variabel perancu.

Hasil: uji korelasi Spearman menunjukkan terdapat hubungan positif bermakna antara kadar LDL dengan severitas sindrom koroner akut dengan nilai p = 0.01 serta koefisien korelasi Spearman sebesar +0,365. Hasil penelitian pada uji analisis diskriminan juga menunjukkan terdapat hubungan positif bermakna antara kadar LDL dengan severitas sindrom koroner akut setelah dianalisis bersama variabel perancu, dengan nilai p = 0,004.

Simpulan: Terdapat hubungan yang positif yang bermakna antara kadar LDL dan severitas sindrom koroner akut pada pasien sindrom koroner akut di RSUP Sanglah

Awareness of male infertility among the medical students in Udayana University of batch 2015

Background: Infertility is defined as the inability to conceive after one year of unprotected sex which was affected eighty million people all over the world. Male infertility is involved in approximately 40% of the more than 2 million infertile married couples in the United States. Health promotion strategies are therefore recommended to begin with educational interventions to increased knowledge of infertility awareness. University years are a time for self-maturation which includes sexual exploration and pregnancy avoidance during this life-course transition to adulthood. There’s still no data about the awareness and knowledge about male infertility among university student especially medical student in Indonesia.

Aim: The study aims to know the level awareness on male infertility among the medical students in Udayana University of batch 2015.

Methods: This study was a descriptive cross-sectional design conducted on June 2018. The subjects were 102 medical students from regular and international class of Faculty of Medicine, Udayana University. The data derived with questionnaires and a preceding informed consent already had been gained from all the participants.

Results: Most of the subjects were belong to the somewhat knowledgeable group (41.2%). English class and female students had the better awareness regarding the male infertility issue (36.8% and 46.7%). The highest percentages of correct answered subtheme questions were diagnosis (55%) subtheme.

Conclusion: Infertility awareness, including knowledge of male risk factors, is a critical first step towards fertility preservation through lifestyle modification.

Gambaran trigliserida, kolesterol total, LDL, dan HDL pada pasien Diabetes Mellitus tipe 2 dengan hipertensi di Rumah Sakit Daerah Mangusada, Badung tahun 2018-2019

Background: Diabetes mellitus (DM) is a chronic condition that occurs when the body can not produce enough insulin or can not use insulin, resulting in an increase of glucose in the blood.  The prevalence of diabetes mellitus continues to increase in most countries which then shows that diabetes mellitus has become a global threat. Indonesia is ranked 5th as the largest number of people with diabetes mellitus. Metabolic syndrome can increase the risk of type 2 DM and cardiovascular disease. As for the main components of the metabolic syndrome include insulin resistance, central obesity, hypertension, and dyslipidemia. Improvement of lipid profile also influences the incidence of hypertension.

Objective: The purpose of this study was to determine the description of triglycerides, total cholesterol, LDL, and HDL in patients type 2 diabetes mellitus accompanied by hypertension.

Methods: This research was conducted at the Mangusada Badung Hospital, in 2019 with a total sample of 52 people from the total sampling method that met the inclusion and exclusion criteria. The design of this study is a cross-sectional study analyzed descriptively.

Results: From the medical record sample of 52 people who visited the Internal Medicine Poly Hospital in Mangusada Regional Hospital, it was found that age > 45 years, female sex, body mass index above overweight had a picture of higher dyslipidemia in the type of lipid profile in the form of total cholesterol and triglycerides. Further research needs to be done to determine the relationship of lipid profile with age, sex, and body mass index and antilipidemic administration as a bias in this study.

Latar Belakang: Diabetes melitus (DM) merupakan kondisi kronik yang terjadi ketika tubuh tidak dapat menghasilkan insulin yang cukup atau tidak dapat menggunakan insulin, sehingga terjadi peningkatan glukosa dalam darah. Prevalensi dari diabetes melitus sendiri terus meningkat di sebagian besar negara yang kemudian hal ini menunjukkan bahwa diabetes melitus telah menjadi ancaman global. Negara Indonesia mendapatkan peringkat ke-5 sebagai jumlah masyarakat yang mengalami diabetes melitus terbanyak. Sindrom metabolik dapat meningkatkan resiko dari DM tipe 2 dan penyakit kardiovaskular. Adapun komponen utama dari sindrom metabolik meliputi resistensi insulin, obesitas sentral, hipertensi, dan dislipidemia. Peningkatan profil lipid juga berpengaruh terhadap kejadian hipertensi.

Tujuan: Tujuan penelitian ini adalah untuk mengetahui gambaran trigliserida, kolesterol total, LDL, dan HDL pada pasien diabetes melitus tipe 2 yang disertai hipertensi.

Metode: Penelitian ini dilakukan di RSD Mangusada Badung, pada tahun 2019 dengan jumlah sampel 52 orang dan metode total sampling yang telah memenuhi kriteria inklusi dan eksklusi. Desain penelitian ini adalah studi potong lintang yang dianalisis secara deskriptif.

Hasil: Dari sampel rekam medis 52 orang yang melakukan kunjungan ke Poli Penyakit Dalam RSD Mangusada didapatkan karakteristik berupa umur > 45 tahun, jenis kelamin perempuan, indeks massa tubuh di atas overweight memiliki gambaran angka dislipidemia yang lebih tinggi pada jenis profil lipid berupa kolesterol total dan trigliserida. Perlu dilakukan penelitian lebih lanjut untuk mengetahui hubungan profil lipid dengan umur, jenis kelamin, dan indeks massa tubuh serta pemberian antilipidemik sebagai bias dalam penelitian ini.

Faktor yang berhubungan dengan perilaku tes HIV pada ibu hamil di Puskesmas Abiansemal I

Background: HIV transmission vertically within children or infants become essential point of view for reducing HIV cases.

Aim: The study aims to find out the related factors of HIV test behavior among pregnant women in public primary healthcare Abiansemal I.

Method: This study used analytical cross-sectional design and consecutive sampling among pregnant women who have routine examination in public primary healthcare Abiansemal I Badung, Bali. Respondents asked to fill a self-administered questionnaire from Health Belief Model to asses of respondent’s perception about HIV screening test.

Result and conclusion: There are 43 pregnant women as respondents with mean age 27 years. Of 49 respondents, 71.4% is pregnant women with equal or below of high school education. 16.3% of respondents did not work and 51% have a good knowledge about HIV. Through bivariate analysis have found gestational age, education level, knowledge, and risk perception have significant associations that can included into multivariate analysis (p<0.25). From multivariate analysis, we found that risk perception have independent association to HIV test among pregnant women (p<0.05; OR 0.121; 95%CI 0.021 – 0.690).

Penularan HIV kepada anak-anak atau bayi menjadi fokus permasalahan penting dalam program reduksi kasus HIV.

Tujuan: Untuk mengetahui faktor yang berhubungan dengan perilaku tes HIV (human immunodeficiency virus) pada ibu hamil di Puskesmas Abiansemal I.

Metode: Penelitian ini menggunakan desain cross-sectional analitik dengan purposive sampling pada sampel ibu hamil yang rutin melakukan pemeriksaan kehamilan di Wilayah Pelayanan Puskesmas Abiansemal I, Badung. Seluruh responden mengisi kuesioner adaptasi health belief model untuk menilai persepsi responden mengenai tes skrining HIV.

Hasil dan simpulan: Total responden pada penelitian ini adalah 49 orang dengan rerata usia 27 tahun. Dari 49 responden tersebut, 71,4% memiliki riwayat pendidikan terakhir, yaitu di bawah atau sama dengan sekolah menengah atas (SMA). Terdapat 16,3% responden yang tidak bekerja dan 51% responden memiliki pengetahuan yang baik mengenai HIV. Melalui analisis bivariat, ditemukan bahwa usia kehamilan, tingkat pendidikan, pengetahuan, dan persepsi risiko memiliki hubungan yang dapat diinklusi dalam analisis multivariat (p<0,25).  Pada analisis multivariat, ditemukan bahwa persepsi risiko memiliki hubungan independen terhadap perilaku tes HIV ibu hamil (p<0,05; OR 0,121; 95%IK 0,021 - 0,690).

Profil pemberian nifedipine kombinasi metildopa dan MgSO4 pada pasien pre-eklamsi berat di Rumah Sakit Daerah Mangusada Badung

Background: Nifedipine are recommended as first line drug choice for gestational hypertensior or severe pre-eclampsia to reduce coroner insufisiency (pectoral angina ofter cardiac infark). Aim: The study aims to determine the usage pattern of nifedipine combined with methyldopa and MgSO₄ for patients with severe pre-eclampsia in RSD Mangusada Badung.

Method: This study is a descriptive study with crossectional method for using the data of patient who seek treatment for severe pre-eclampsia at RSD Mangusada Badung in 2019. Nifedipine with some kind of combination aspecially anticonvulsant MgSO₄ are given in the range of  2-4 days which is nifedipine are given orally and the MgSO4 are given by using IV line as a loading dose for the first step and maintenance treathment by infusion drip with appropriate monitoring. There were no monotherapy of nifedipine are found but using MgSO₄ as a protocol for all the patient (100%) with severe pre-eclampsia as a convulsion prophylaxis.

Results: The condision of severe pre-eclmpsia at RSD Mangusada Badung Tahun 2019 are followed by some patient’s characteristic are most prevalent in the age group of  > 35 years as many as 9 people (56.25%),  characteristic of pre-eclmpsia’s history as many as  5 people (55.56%), characteristic of deases history as many as 14 people (87.5%), characteristic of BMI (body mass index) are obesity degree I and II there are 11 people (68.8%) dan 4 people (25,0%) for each obesity’s character, characteristic of  gestational age are most prevalent in the age group of  20-< 37 weeks as many as 10 people (62,5%) and all of them are without multiple pregnancy.

Conclusion: The profile of nifedipine therapy for severe hypertension are given by using nifedipine orally combine with MgSO₄ for convultion prophylaxis as a dominan result which is about 15 cases (93.75%) and all of them are showing there are no complication symptom.

Nifedipine secara umum digunakan bagi pengobatan dan pencegahan insufisiensi koroner (terutama angina pektoris setelah infark jantung) dan sebagai terapi lini-1 pada hipertensi dalam kehamilan khususnya pada kejadian preeklampsia berat.

Tujuan: Tujuan penelitian ini adalah untuk mengetahui profil pemberian nifedipine kombinasi metildopa dan MgSO₄ pada pasien PEB (pre-eklamsi berat) di Rumah Sakit Daerah (RSD) Mangusada Badung.

Metode: Penelitian ini merupakan penelitian deskriptif dengan metode crossestional pada pasien preeklamsia berat yang berobat di RSD Mangusada Badung tahun 2019. Profil pemberian nifedipine pada pasien preeklamsia berat di RSD Mangusada Badung tahun 2019 dengan pemberian terapi nifedipine dilakukan per oral dan antikonvulsan dalam hal ini MgSO₄ dengan cara injeksi IV bolus dan drip. Tidak ada pemberian nifedipine monoterapi, melainkan pemberian anti konvulsan MgSO₄ kepada semua pasien (100%) yang terdiagnose PEB.

Hasil: Karakteristik pasien preeklamsia berat berdasarkan umur paling banyak pada kelompok usia > 35 tahun sebanyak 9 orang (56,25%) dengan pengulangan riwayat PEB/eklamsia  berjumlah 5 orang (55,56%) dan paling banyak tanpa riwayat penyakit sebelumnya sejumlah 14 orang (87,5%), dengan kondisi IMT (index massa tubuh) didapatkan dominan obesitas I dan II yaitu masing-masing 11 orang (68,8%) dan 4 orang (25,0%) serta ditemukan paling banyak pada usia 20 minggu - <37 minggu yaitu 10 orang (62,5%) serta tidak ada yang memiliki kehamilan multiple.

Simpulan: Profile pemberian nifedipine kombinasi dengan anti konvulsan sebanyak 15 orang (93,75%) dengan seluruhnya tidak ditemukan efek samping dan lama pengobatan di rumah sakit dengan kurun waktu 2-4 hari perawatan.

Hubungan konsumsi kopi hitam terhadap tekanan darah pada perokok dewasa

Background: Unhealthy lifestyles such as smoking and consuming coffee can affect blood pressure.

Aim: The study aims to evaluate the association between black coffee consumption and hypertension.

Method: This study design was cross-sectional with 93 participants. Data taken from questionnaire measurements and blood pressure measurements at a time.

Results and conclusion: The results showed 79.6% had abnormal blood pressure and 20.4% had normal blood pressure. In this study male smoker workers who consumed black coffee were statistically related to blood pressure (p <0.05).

Pola hidup yang tidak sehat seperti merokok dan mengkonsumsi kopi dapat mempengaruhi tekanan idarah.

Tujuan: Untuk mengevaluasi hubungan konsumsi kopi hitam dan tekanan darah.

Metode: Desain penelitian ini cross-sectional dengan 93 peserta sampel. Data yang diambil berasal dari pengukuran kuisioner dan pengukuran tekanan darah sewaktu.

Hasil dan simpulan: Terdapat 79,6% sampel memiliki tekanan idarah tidak normal dan 20,4% memiliki tekanan darah normal. Dalam penelitian ini pekerja laki-laki perokok yang mengkonsumsi kopi hitam berhubungan secara statistik dengan tekanani darah (p < 0,05).

Hubungan tingkat pengetahuan ibu tentang pencegahan diare dengan kejadian diare pada balita di Desa Pemecutan Kelod, Denpasar, Bali

Background: In Indonesia, 100,000 infants died caused by diarrhea annually. In 2014, diarrhea sufferers were found mostly in Community Health Center II West Denpasar. In 2015, primarily located in Desa Pemecutan Kelod, which is in the working area of Community Health Center II West Denpasar. The occurrence of diarrhea in children cannot be separated from the role of their mothers. This study aims to determine the relationship of mothers’ knowledge level on prevention of diarrhea with the occurrence of diarrhea in under-five children in Desa Pemecutan Kelod.

Methods: A cross sectional analytic design was conducted among 90 samples. The variables studied were mothers’ knowledge as an independent variable and diarrhea in under-five children as a dependent variable. The instrument used in this study was a questionnaire that has been examined for validity. Data were analyzed using SPSS version 17 for Windows.

Results: The results showed that most respondents had good knowledge of 63.3%, around 38.6% of the under-five children suffered diarrhea. Mothers with sufficient knowledge (21.1%), approximately 42.1% of the under-five children suffered diarrhea, and mothers with inadequate knowledge (15.6%), around 78.6% of the under-five children suffered diarrhea. There was a significant relationship between mothers’ knowledge level in preventing diarrhea and diarrhea in under-five children (p=0.025).

Conclusion: Based on the study results, particularly regarding the fact there was still a low level of mothers’ knowledge, it is recommended the health center staff give proper health education on the prevention of diarrhea.

Latar Belakang: Setiap tahun di Indonesia 100.000 balita meninggal karena diare. Pada tahun 2014 di temukan penderita diare di Provinsi Bali terbanyak di Wilayah Kerja Puskesmas II Denpasar Barat, sedangkan pada tahun 2015 terbanyak di Desa Pemecutan Kelod yang merupakan wilayah kerja Puskesmas II Denpasar Barat. Tingginya angka kejadian diare pada anak tidak lepas dari pengetahuan ibu. Penelitian ini bertujuan untuk mengetahui hubungan tingkat pengetahuan ibu tentang pencegahan diare dengan kejadian diare pada balita di Desa Pemecutan Kelod. 

Metode: Penelitian ini menggunakan desain penelitian analytic cross sectional dengan 90 sampel yang dipilih secara random sampling. Variabel yang diteliti adalah pengetahuan ibu sebagai variabel bebas dan kejadian diare pada balita sebagai variabel tergantung. Instrumen yang digunakan pada penelitian ini adalah kuesioner yang telah diuji validitas. Data dianalisis dengan SPSS version 17 for Windows.

Hasil: Hasil penelitian menunjukkan sebagian besar (63,3%) ibu memiliki pengetahuan baik, dan sebanyak 38,6% balitanya mengalami diare. Pada 21.1% ibu dengan pengetahuan cukup, sebanyak 42,1% balitanya mengalami diare, dan pada 15,6% ibu yang memiliki pengetahuan kurang sebanyak 78,6% balitanya mengalami diare. Terdapat hubungan yang bermakna antara tingkat pengetahuan ibu tentang pencegahan diare dengan kejadian diare pada balita (p=0,025).

KesimpulanBerdasarkan hasil penelitian ini, terutama dengan kenyataan masih ada pengetahuan ibu yang kurang, disarankan agar petugas kesehatan memberikan penyuluhan tentang pencegahan diare.

Hubungan Bayi Berat Lahir Rendah (BBLR) dengan kejadian hiperbilirubinemia pada neonatus di RSUD Wangaya, Bali, Indonesia

Background: Hyperbilirubinemia is one of the clinical phenomena most often found in newborns and occurs in 60% of > 35 weeks neonates and 80% of < 35 weeks neonates.  Hyperbilirubinemia is one of the most common causes of infant death (2012, SDKI).  Prevalence and severity of hyperbilirubinemia are found to be higher in newborns with low birth weight (LBW). This study aims to determine the relationship between LBW and incidence of hyperbilirubinemia in neonates at Wangaya hospital.

Methods: This study was an observational analytic study with cross sectional approach conducted in August – September 2019 at Wangaya hospital.  The study subjects were 98 infants aged 0-28 days admitted to Wangaya hospital from August-September 2019 and met the inclusion and exclusion criteria. The subjects were taken by consecutive sampling. Bivariate analysis was performed using the Chi-Square test and calculation of prevalence ratio. Data were analyzed by SPSS version 17 for Windows.

Results: In this study, 98 samples were obtained, and from all of them, as much as 24.5% were found to be LBW, and 9 of them were experiencing hyperbilirubinemia. The result of hypothesis testing with the Chi-Square test obtained p-value=0.042 and PR-value=2.13.

Conclusions: A significant correlation between LBW and incidence of hyperbilirubinemia in neonates at Wangaya hospital and LBW is a risk factor for the incidence of hyperbilirubinemia in neonates.

Latar Belakang: Hiperbilirubinemia merupakan salah satu fenomena klinis yang paling sering ditemukan pada bayi baru lahir dimana hiperbilirubinemia terjadi pada 60% dari neonatus > 35 minggu dan 80% dari neonatus < 35 minggu. Berdasarkan SDKI tahun 2012, hiperbilirubinemia merupakan salah satu penyebab kematian bayi tersering. Pravelensi dan tingkat keparahan hiperbilirubinemia ditemukan lebih tinggi pada bayi berat lahir rendah (BBLR). Penelitian ini bertujuan untuk mengetahui hubungan BBLR dengan kejadian hiperbilirubinemia pada neonatus di RSUD Wangaya.

Metode: Penelitian ini merupakan penelitian observasional analitik dengan pendekatan potong lintang yang dilaksanakan pada bulan Agustus – September 2019 di RSUD Wangaya. Subjek penelitian adalah bayi usia 0-28 hari yang dirawat di RSUD Wangaya selama bulan Agustus – September 2019 yang memenuhi kriteria inklusi dan eksklusi. Pengambilan sampel penelitian dilakukan secara consecutive sampling. Dilakukan analisis bivariat menggunakan uji Chi-Square dan menggunakan perhitungan rasio prevalensi. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Pada penelitian ini didapatkan sampel sebanyak 98 sampel, dimana didapatkan sampel BBLR sebesar 24,5% dan 9 sampel diantaranya mengalami hiperbilirubinemia. Hasil uji hipotesis dengan uji Chi-Square diperoleh nilai p=0,042 dan nilai RP=2,13.

Simpulan: Terdapat hubungan yang bermakna antara BBLR dengan hiperbilirubinemia pada nenonatus di RSUD Wangaya dan BBLR merupakan faktor resiko terhadap kejadian hiperbilirubinemia pada neonatus.

Hubungan antara osteopontin dengan rasio Ca : Mg dan nilai Ca X P: Studi pada penderita penyakit ginjal tahap akhir

Background: End-stage renal disease (ESRD) can impair mineral metabolisms in the human body, such as calcium (Ca), magnesium (Mg), and phosphate (P). Osteopontin is released by the kidneys and inhibits vascular calcification. Examination of the Ca:Mg ratio and Ca x P product in ESRD to see vascular calcification complications and is considered better than a single examination.

Objective: To analyze the correlation of osteopontin levels with the ratio of Ca: Mg and product Ca x P in ESRD patients.

Methods: Analytic observational study with cross sectional approach was conducted in February-June 2019 involving 30 ESRD patients while hemodialysis at Permata Medika Hospital in Semarang with consecutive sampling. They were screened according to the inclusion and exclusion criteria. Calcium, magnesium and phosphate levels were measured using K lite cornley with the Ion-Selective Electrode (ISE) method. The Ca:Mg ratio and Ca x P product were calculated manually. Osteopontin levels were measured using the ELISA method. Correlation using Spearman test with p<0.05 was considered significant.

 Results: The median Ca:Mg ratio was 4.63 (3.27 - 5.58) and the Ca x P product was 58.26 mg²/dl² (19.53 - 111.24). Correlation of osteopontin with Ca:Mg ratio and Ca x P product are respectively with r=0.370 (p=0.044) and with r=0.406 (p=0.026).

Conclusion: Osteopontin is correlated to the level of Ca:Mg ratio and Ca x P product in ESRD patients.

Latar belakang: Penyakit ginjal tahap akhir (PGTA) dapat mempengaruhi metabolisme mineral, seperti kalsium (Ca), magnesium (Mg), dan fosfat (P). Osteopontin yang dikeluarkan oleh ginjal berfungsi menghambat kalsifikasi vaskuler. Pemeriksaan rasio Ca:Mg dan nilai Ca x P pada PGTA untuk melihat komplikasi kearah kalsifikasi pembuluh darah dan dianggap lebih baik daripada pemeriksaan tunggal.

Tujuan: Menganalisis korelasi kadar osteopontin dengan rasio Ca:Mg dan nilai Ca x P pada pasien PGTA.

Metode: Penelitian observasional analitik dengan pendekatan potong lintang dilakukan pada bulan Februari-Juni 2019 melibatkan 30 pasien PGTA saat melakukan hemodialisis di RS Permata Medika Semarang yang memenuhi kriteria inklusi dan ekslusi dengan teknik consecutive sampling. Kadar kalsium, magnesium dan fosfat diukur menggunakan alat K lite cornley dengan metode Ion Selective Electrode (ISE) dan rasio Ca:Mg dan Ca x P dihitung manual. Pemeriksaan kadar osteopontin menggunakan metode ELISA. Analisis statistika menggunakan uji Spearman dengan p<0,05 dianggap bermakna.

Hasil: Hasil median rasio Ca:Mg adalah 4,63 (3,27 – 5,58) dan nilai Ca x P adalah  58,26 mg²/dl² (19,53 – 111,24). Korelasi osteopontin dengan rasio Ca:Mg dan nilai Ca x P berturut-turut adalah r= 0,370 (p=0,044) dan r=0,406 (p=0,026).

Simpulan: Kadar osteopontin berkorelasi dengan rasio Ca:Mg dan nilai Ca x P pada pasien PGTA.

Karakteristik hipertensi pada anak di Instalasi Rawat Inap (IRNA) RSUP Sanglah, Bali, Indonesia

Background: The prevalence of hypertension in children and adolescents has increased in the last decade. Hypertension in children is associated with hypertension in adults that have not been treated well and one of the risk factors for cardiovascular disease, kidney disease, and other organ damage. Data on hypertension in children is still limited, especially in Indonesia. This study aims to determine the characteristics of children with hypertension in the inpatient installation of Sanglah Hospital Denpasar.

Methods: This is a retrospective cross-sectional study with a descriptive design. Data were collected from pediatric patients' medical records age 1-18 years old diagnosed with hypertension in 2018-2019. Variables assessed in this study were gender, age, etiology of hypertension, symptoms, and number of antihypertensive therapies. Data were analyzed using SPSS version 22 for Windows.

Results: A total of 56 children with hypertension were included in this study. Subjects were dominated by the female (53.6%), ages 6-13 years (46.4%) with a median age of 11 years, and well-nourished (46.4%). The etiology of hypertension for all subjects is secondary hypertension, mostly caused by kidney disease (75%). Hypertension symptoms are generally not specific; headache is the most common symptom of hypertensive crisis (35.7%). Stage 2 hypertension is most common in this study (57.1%); hypertensive crises mostly occur in children aged ?13 years and are treated in the intensive care unit. Children with stage 2 hypertension and hypertensive crisis tend to show uncontrolled hypertension upon hospital discharge (44.4%). The majority of children received single antihypertensive therapy (51.8%).

Conclusion: The etiology of hypertension in children is mostly secondary hypertension caused by kidney disease. Second-degree hypertension is the most common hypertension in children who are treated with hypertension. The outcome is mainly controlled hypertension with single antihypertensive therapy.

Latar belakang: Angka kejadian hipertensi pada anak dan remaja mengalami peningkatan dalam dekade terakhir. Hipertensi pada anak erat kaitannya dengan kejadian hipertensi pada dewasa yang tidak ditata laksana dengan baik, dan salah satu faktor risiko timbulnya penyakit kardiovaskuler, ginjal dan kerusakan organ lain. Data mengenai hipertensi pada anak masih terbatas terutama di Indonesia. Penelitian ini bertujuan untuk mengetahui karakteristik hipertensi pada anak di Instalasi Rawat Inap RSUP Sanglah Denpasar.

Metode: Penelitian ini merupakan penelitian potong lintang retrospektif menggunakan rancangan deskriptif. Data diambil dari rekam medis pasien anak berusia 1-18 tahun yang dirawat dengan hipertensi pada tahun 2018-2019. Variabel yang dinilai pada penelitian ini adalah Jenis kelamin, usia, etiologi hipertensi, gejala, dan jumlah obat anti hipertensi. Data dianalisis dengan SPSS versi 22 untuk Windows.

Hasil: Sebanyak 56 anak dengan hipertensi diikutkan dalam penelitian ini. Subjek didominasi oleh jenis kelamin perempuan (53,6%), usia 6-13 tahun (46,4%) dengan median usia 11 tahun, dan gizi baik (46,4%). Etiologi hipertensi seluruh subjek adalah hipertensi sekunder yang paling banyak disebabkan oleh penyakit ginjal (75%). Gejala hipertensi secara umum tidak spesifik; sakit kapala merupakan gejala yang paling sering dikeluhkan pada krisis hipertensi (35,7%). Hipertensi derajat 2 paling banyak ditemukan pada subjek (57,1%); krisis hipertensi sebagian besar terjadi pada anak berusia ?13 tahun dan dirawat di ruang intensif. Anak dengan hipertensi derajat 2 dan krisis hipertensi cenderung menunjukkan hipertensi yang tidak terkontrol saat keluar rumah sakit (44,4%). Mayoritas anak mendapatkan terapi antihipertensi tunggal (51,8%).

Kesimpulan: Hipertensi pada anak mayoritas adalah hipertensi sekunder yang disebabkan oleh penyakit ginjal. Hipertensi derajat 2 adalah hipertensi yang paling banyak ditemukan pada anak yang dirawat dengan hipertensi. Sebagian besar memiliki luaran hipertensi yang terkontrol dengan terapi antihipertensi tunggal.

Analisis rasio profil lipid kolesterol total, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), dan trigliserida pada pasien Diabetes Melitus Tipe 2 (DM-2) dengan dan tanpa komplikasi ulkus kaki diabetik

Background: One of the serious macrovascular complications in type 2 diabetes mellitus is a diabetic foot ulcer. Besides causing chronic complications of diabetes, poor glycemic control can also cause dyslipidemia, which plays a role in diabetic foot ulcers' pathophysiology. The ratio of total cholesterol/HDL cholesterol, LDL cholesterol/HDL cholesterol, and triglyceride/HDL ratio play a role in the pathophysiology of endothelial dysfunction closely related to diabetic foot ulcers.

Methods: A retrospective study was performed at the DR. Wahidin Sudirohusodo Hospital, Makassar, by taking secondary data from type 2 DM patient medical records from January 2018 to September 2019. The study sample consisted of forty-seven patients with diabetic foot ulcer complications and 50 patients without diabetic foot ulcers. Chi-Square, Independent T test, and Mann-Whitney test were used as statistical analysis by SPSS version 17 for Windows.

Results: Total cholesterol to HDL ratio and LDL to HDL ratio are significantly greater in type 2 DM patients with diabetic foot ulcer compare to those without diabetic foot ulcers (7.70±6.62 vs. 5.21±1.55, p=0.040 and 4.93±4.75 vs. 3.21±1.16, p=0.014, respectively). There is no significant difference in triglycerides to HDL ratio in type 2 DM with and without diabetic foot ulcers (7.73±8.82 vs. 4.43±3.44, p=0.053). Receiver Operating Curve (ROC) analysis has found cut-off of Total Cholesterol to HDL ratio is 7.13 and LDL to HDL ratio is 3.58.

Conclusion: Total cholesterol to HDL ratio and LDL to HDL ratio are show more relationship with diabetic foot ulcer events.

Latar Belakang: Komplikasi makrovaskuler yang serius dari dari diabetes melitus tipe 2 salah satunya adalah ulkus kaki diabetik. Kontrol glikemik yang buruk, selain dapat menyebabkan komplikasi kronik dari diabetes, juga dapat menyebabkan dislipidemia yang berperan dalam patofisiologi terjadinya ulkus kaki diabetik. Rasio kolesterol total/kolesterol HDL, kolesterol LDL/kolesterol HDL, dan rasio trigliserida/HDL berperan dalam patofisiologi disfungsi endotel yang erat kaitannya dengan komplikasi ulkus kaki diabetik.

Metode: Penelitian retrosepektif ini dilakukan pada Rumah Sakit DR. Wahidin Sudirohusodo Makassar dengan mengambil data rekam medis pasien diabetes melitus tipe 2 periode Januari 2018 sampai September 2019. Sampel penelitian terdiri dari empat puluh tujuh pasien diabetes melitus dengan komplikasi ulkus kaki diabetik dan lima puluh pasien tanpa komplikasi ulkus kaki diabetik. Uji statistik yang digunakan adalah Chi Square, uji T tidak berpasangan, dan uji Mann-Whitney dengan SPSS versi 17 untuk Windows.

Hasil: Rasio kolesterol total/HDL dan LDL/HDL berturut-turut lebih besar pada pasien DM tipe 2 dengan ulkus kaki diabetik dibandingkan tanpa ulkus kaki diabetik (7,70±6,62 vs 5,21±1,55, p = 0,040 dan 4,93±4,75 vs 3,21±1,16, p=0,014). Tidak terdapat perbedaan bermakna rasio trigliserida/HDL pasien DM tipe 2 dengan ulkus kaki diabetik (7,73±8,82 vs 4,43±3,44, p=0,053). Menurut analisis Receiver Operating Curve (ROC) cutoff rasio kolesterol total/HDL sebesar 7,13 sedangkan untuk rasio LDL/HDL dipilih cutoff 3,58.

Kesimpulan: Rasio Kolesterol total/HDL dan rasio LDL/HDL menunjukkan hubungan dengan kejadian ulkus kaki diabetik.

Evaluasi kasus meningioma di Rumah Sakit Wahidin Sudirohusodo Makassar tahun 2012-2018

Background: Meningioma is the most common tumor of the primary central nervous system (CNS) tumor, covering one-third or 36.4% of all tumors in the CNS. Some of the risk factors that are thought to be associated with meningioma include ionizing radiation, lifestyle, genetic factors, head trauma, and hormonal factors. However, until now, there are no factors that significantly and consistently have a direct relationship with the occurrence of meningioma. This study aimed to evaluate cases of meningioma at the Wahidin Sudirohusodo Hospital Makassar in 2012-2018.

Methods: A cross-sectional study with a descriptive and retrospective approach was conducted from the medical records of neurosurgical patients treated at the Wahidin Sudirohusodo Hospital Makassar in 2012-2018. The variables assessed in this study included gender, age group, tumor location, and variations in meningioma pathology. Data were analyzed using SPSS version 17 for Windows.

Results: Most of the study respondents were female (72.1%) than males (27.9%). The 51-60 year age group contributed to 32.4% of meningioma cases. The tumor's location was found most frequently in the parietal (29.4%) followed by the frontal (22.1%). Based on the variety of pathology, meningothelial meningioma was the most frequent case in Grade 1 (11.8%), followed by Atypical meningioma in Grade II (22.1%), and Anaplastic meningioma in Grade III (23.5%).

Conclusion: Meningioma cases at Wahidin Sudirohusodo Hospital Makassar in 2012-2018 were partly female, age group 51-60 years, parietal location, and differences in pathological variations in each grade.

Latar Belakang: Meningioma merupakan tumor tersering dari tumor primer susunan saraf pusat (SSP) yang meliputi sepertiga atau 36,4 % dari seluruh tumor pada SSP. Beberapa faktor resiko yang diduga berhubungan dengan terjadinya meningioma meliputi radiasi ion, pola hidup, faktor genetik, trauma kepala, dan faktor hormonal. Akan tetapi, hingga saat ini belum ada faktor yang secara bermakna dan konsisten berhubungan langsung dengan terjadinya meningioma. Peneltiian ini bertujuan untuk mengevaluasi kasus meningioma di Rumah Sakit Wahidin Sudirohusodo Makassar tahun 2012-2018

Metode: Penelitian ini bersifat potong lintang dengan pendekatan secara deskriptif dan retrospektif yang bersumber dari data rekam medis pasien bedah saraf yang dirawat di Rumah Sakit Wahidin Sudirohusodo Makassar tahun 2012-2018. Variabel yang dinilai pada penelitian ini meliputi Jenis kelamin, kelompok umur, lokasi tumor, dan variasi patologi meningioma. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar responden penelitian diketahui berjenis kelamin perempuan (72,1%) dibandingkan laki-laki (27,9%). Kelompok umur 51-60 tahun berkontribusi terhadap 32,4% kasus meningioma. Lokasi tumor ditemukan paling sering pada bagian parietal (29,4%) diikuti dengan bagian frontal (22,1%). Berdasarkan variasi patologi, Meningothelial Meningioma merupakan kasus yang paling sering pada Grade 1 (11,8%), diikuti dengan Atypical Meningioma pada Grade II (22,1%), dan Anaplastic meningioma pada Grade III (23,5%).

Kesimpulan: Kasus meningioma di Rumah Sakit Wahidin Sudirohusodo Makassar tahun 2012-2018 sebagian berjenis kelamin perempuan, kelompok usia 51-60 tahun, lokasi parietal, dan perbedaan variasi patologi pada masing-masing Grade.

Hubungan antara Neutrophil-Lymphocyte Ratio (NLR) dengan Tumor-Infiltrating Lymphocyte (TIL), staging, dan grading histopatologi pasien kanker kolorektal di RSUP Sanglah, Bali, Indonesia

Background: Colorectal Cancer (CRC) is a significant public health problem in Indonesia. Inflammation is said to have an essential role in the pathogenesis and progressiveness of the CRC. The ratio of neutrophils and lymphocytes (NLR) is a marker that is easily measured. It is hoped that this ratio can be a useful, inexpensive, and fast marker that is routinely carried out, especially for CRC patients.

Methods: This study was an analytic cross-sectional design study to determine the relationship between NLR and TIL, histopathology, and TNM stage in patients with TRC. The variables assessed in this study included age, gender, NLR, TIL, grading, stage, and Receiver Operating Curve (ROC) analysis of the relationship between NLR and colorectal cancer stage. Data were analyzed using SPSS version 17 for Windows.

Results: There was no significant correlation (p=0.301) between NLR and TIL. The correlation of NLR with histopathological grading was also not significant (p=0.250). There was a significant correlation between NLR with the CRC staging (p<0.001). NLR's cut-off point for staging was determined to be 4.0 with a sensitivity of 98% and a specificity of 95%. This correlation has an Odd-Ratio (OR) of 465.500 and p<0.001 so that the correlation is significant. Obtained correlation coefficient (r) NLR with CRC patient stage of 0.898, where this value has a strong correlation (r> 0.75).

Conclusion: High NLR is associated with advanced stage in CRC with an NLR cut-off point of 4.

Latar Belakang: Kanker kolorektal (KKR) merupakan masalah kesehatan masyarakat di Indonesia.  Inflamasi dikatakan memiliki peran penting dalam patogenesis dan progesifitas KKR. Rasio neutrofil dan limfosit (NLR) merupakan suatu marker yang mudah diukur. Diharapkan rasio ini dapat menjadi salah satu marker yang bermanfaat, murah dan cepat serta rutin dilakukan khususnya pada pasien KKR

Metode: Penelitian ini merupakan suatu penelitian rancangan potong lintang analitik untuk mengetahui hubungan antara NLR dengan TIL, histopatologi, dan stadium TNM pada pasien dengan KKR. Variabel yang dinilai pada penelitian ini meliputi Usia, jenis kelamin, NLR, TIL, grading, stadium, maupun analisis Receiver Operating Curve (ROC) hubungan NLR dengan stadium kanker kolorektal. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Tidak didapatkan hubungan yang bermakna (p=0,301) antara NLR dengan TIL. Hubungan NLR dengan grading histopatologi juga tidak bermakna (p=0,250). Terdapat hubungan yang bermakna antara NLR dengan stadium KKR (p<0.001). Cut-off point NLR terhadap stadium ditentukan sebesar 4.0 dengan sensitivitas 98% dan spesifisitas 95%.  Hubungan ini memiliki Odd-Ratio sebesar 465.500 dan p < 0.001 sehingga hubungannya bermakna. Didapatkan koefisien korelasi (r) NLR dengan stadium pasien KKR sebesar 0.898 dimana nilai ini memiliki korelasi yang kuat (r > 0.75).

Kesimpulan: NLR tinggi berhubungan dengan stadium yang tinggi pada kasus KKR dengan nilai cut off point NLR adalah 4. 

Konfigurasi fraktur Schatzker VI dan malalignment merupakan faktor risiko terjadinya joint narrowing pada fraktur tibia plateau di RSUP Sanglah, Bali, Indonesia

Background: Tibia plateau fracture is a fracture that involves the joint surface and dramatically contributes to the early development of knee osteoarthritis, which can lead to disability. The joint narrowing is one of the most initial signs of knee osteoarthritis. Until now, the mechanism of joint narrowing is not known with certainty but is thought to be related to the configuration of the patient's fracture, malalignment, and BMI. This study aims to determine and analyze the effect of Schatzker VI fracture configuration, malalignment, and BMI > 25 kg/m² on joint narrowing in post-operative tibia plateau fracture patients.

Methods: This research is an observational study with a case-control design. Thirty-eight patients with tibia plateau fractures who had surgery with acceptable reduction were followed-up within 12-15 months post-operatively. The control group consisted of patients who did not experience joint narrowing post-operatively, while the case group are patients with joint narrowing. Schatzker classification, malalignment, and BMI were compared and statistically analyzed for significance. Data were analyzed using SPSS version 21 for Windows.

Results: Sixteen patients (84,0%) had Schatzker VI with a risk of 11.56 times to experience joint narrowing (p=0.003). Malalignment were 18 samples (47,0%), with a risk of 11,56 times becoming joint narrowing (p=0.003); and 8 samples with BMI > 25 kg/m² had a risk of 0.802 times to develop joint narrowing (p=1.000).

Conclusion: Schatzker VI configuration and malalignment are risk factors for joint narrowing in patients following tibial plateau surgery, while a BMI is not a risk factor for joint narrowing.

Latar Belakang: Fraktur tibia plateau merupakan fraktur yang melibatkan permukaan sendi dan sangat berkontribusi terhadap perkembangan dini osteoartritis lutut yang dapat berujung pada timbulnya disabilitas. Joint narrowing merupakan salah satu tanda awal terjadinya osteoartritis lutut. Sampai saat ini mekanisme terjadinya joint narrowing belum diketahui secara pasti namun diduga terkait dengan konfigurasi fraktur, malalignment, dan BMI pasien. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh konfigurasi fraktur Schatzker VI, malalignment, dan BMI > 25 kg/m² terhadap terjadinya joint narrowing pada pasien pasca operasi fraktur tibia plateau.

Metode: Penelitian ini merupakan studi observasional dengan desain case control. Tiga puluh delapan pasien yang menjalani operasi fraktur tibia plateau diamati dalam 12-15 bulan pasca operasi. Kelompok kontrol terdiri dari pasien yang tidak mengalami joint narrowing pasca operasi sedangkan kelompok kasus terdiri dari pasien yang mengalami joint narrowing. Klasifikasi Schatzker, malalignment, dan BMI dibandingkan dan dianalisis secara statistik untuk signifikansi.

Hasil: Enam belas pasien (84,0%) memiliki konfigurasi fraktur Schatzker VI berisiko 11,56 kali mengalami joint narrowing (p=0,003); malalignment dengan 18 sampel (47%), berisiko 11,56 kali menjadi joint narrowing (p=0,003); dan sampel dengan BMI> 25 kg/m² adalah 8 sampel dan berisiko 0,802 kali untuk mengalami joint narrowing (p=1.000).

Simpulan: Konfigurasi Schatzker VI fraktur tibia plateau dan malalignment adalah faktor risiko untuk terjadinya joint narrowing pada pasien yang pasca operasi fraktur tibia plateau, sementara BMI > 25kg/m² bukan merupakan faktor risiko terjadinya joint narrowing.

Pemberian kombinasi kalsium dengan asam askorbat meningkatkan kadar bone alkaline phosphatase dan osteocalcin serum dibandingkan kombinasi kalsium dengan vitamin D3 pada patah tulang panjang paska fiksasi internal di RSUP Sanglah, Bali, Indonesia

Background: It is expected that supplementation will be able to satisfy the needs of calcium as well as improve the process of fracture healing. The goal of this study is to show the efficacy of calcium and ascorbic acid (vitamin C) combination supplements in fracture bone healing compared to calcium and vitamin D3.

Methods. This study is a randomized clinical trial involving 30 patients with long bone fractures of the lower extremity who have undergone internal fixation and are split into two classes. The calcium carbonate-ascorbic acid regiment combination was given to one group, while the calcium carbonate-vitamin D3 regiment was given to the other group. The effect of the regiment was tested on serum calcium, bone alkaline phosphatase (BAP) and osteocalcin (OC) levels. The findings were compared and interpreted statistically by SPSS version 21 for Windows.

Results. Administration of calcium carbonate and ascorbic acid combination was be able to increase serum calcium significantly (p = 0.00, 95% CI = 0.59 – 0,87), but not as strong as combination of calcium carbonate with vitamin D3. An increased level of serum BAP and OC was found significantly higher in calcium carbonate and ascorbic acid supplementation group (p value = 0,033, CI -4,18 – -0,19 for BAP, p value = 0,04, CI -2,25 – -0,49 for OC).

Conclusion. The administration of calcium carbonate and ascorbic acid combination supplement increases the serum calcium level, but not as strong as calcium carbonate and vitamin D3 combination.

Latar Belakang: Pemberian suplemen diharapkan mampu untuk memenuhi kebutuhan kalsium sekaligus mempercepat proses penyembuhan patah tulang. Penelitian ini bertujuan untuk mengetahui keefektifan suplemen kalsium dan asam askorbat (vitamin C) dalam penyembuhan tulang pasca patah tulang dibandingkan pemberian suplemen kalsium dan vitamin D3.

Metode: Penelitian ini merupakan uji klinis terandomisasi yang melibatkan 30 pasien patah tulang panjang ekstremitas bawah pasca fiksasi internal yang kemudian dibagi menjadi dua kelompok. Satu kelompok diberikan suplemen kombinasi kalsium karbonat-asam askorbat sedangkan kelompok lainnya diberikan kombinasi kalsium karbonat-vitamin D3. Efeknya terhadap kadar serum kalsium, bone alkaline phosphatase (BAP), dan osteocalcin (OC) kemudian diperiksa dan dibandingkan antara kadar sebelum dengan setelah perlakuan. Analisis statistik dilakukan dengan SPSS versi 21 untuk Windows.

Hasil: Pemberian kombinasi kalsium karbonat-asam askorbat mampu meningkatkan serum kalsium secara bermakna (p=0.00, IK 95% = 0.59 – 0,87), namun tidak lebih kuat dibandingkan kombinasi kalsium karbonat-vitamin D3. Peningkatan kadar BAP dan OC juga ditemukan lebih tinggi secara bermakna pada kelompok dengan suplementasi kalsium karbonat-asam askorbat (nilai p 0,033 IK -4,18 – -0,19 untuk BAP, nilai p = 0,04, IK -2,25 – -0,49 untuk OC) apabila dibandingkan dengan suplementasi kalsium karbonat-vitamin D3.

Simpulan: Pemberian kombinasi kalsium karbonat dan asam askorbat terbukti dapat meningkatan kadar serum kalsium, namun tidak sekuat pada kombinasi kalsium dan vitamin D3.

Hitung trombosit metode otomatis dikonfirmasi dengan Hapusan Darah Tepi (HDT) tanpa pewarnaan dan dengan pewarnaan giemsa di RSUP Sanglah, Bali, Indonesia

Background: The platelet count calculation is a basic hematological examination, which is indispensable due to laboratory tests that are important for making clinical decisions. However, in practice, it was found that several methods of examining the platelet count showed inconsistent results. Therefore, this study aims to determine the platelet count's suitability on the peripheral blood smear with staining, without staining, and automatic platelet count using the flowcytometry method.

Methods: This study used an observational method on 36 samples. A blood smear without staining and staining was made, read on a microscope with a magnification of 1,000 times, then compared with the platelet count results by the flowcytometry method. The data were then performed statistical tests using the One-Way ANOVA test, followed by the post-hoc test. Data were analyzed using SPSS version 17 for Windows.

Results: Most of the respondents were female (55.56%) and had a mean age of 42.37 ± 20.90 years. From the One-Way ANOVA test, it was found that there was no difference in the platelet count between groups of the calculation method used (p = 1,000). The post-hoc test also showed that the results of the calculation of the automatic tool flowcytometry method were compatible with the stained and non-stained peripheral blood smear (p> 0.05).

Conclusion: There is an agreement between the unstained method, staining, and flowcytometry.

Latar Belakang: Perhitungan jumlah trombosit merupakan pemeriksaan hematologi dasar dimana sangat diperlukan sebagai hasil pemeriksaan laboratorium yang penting untuk membuat keputusan klinis. Akan tetapi dalam pelaksanaannya ditemukan bahwa beberapa metode pemeriksaan jumlah trombosit menunjukkan hasil yang tidak sesuai. Oleh karena itu penelitian ini bertujuan untuk mengetahui kesesuaian antara hitung trombosit pada hapusan darah tepi dengan pewarnaan, tanpa pewarnaan dan hitung trombosit otomatis dengan metode flowcytometry.

Metode: Penelitian menggunakan metode observasional pada 36 sampel. Dibuat hapusan darah tepi tanpa pewarnaan dan dengan pewarnaan, dibaca pada mikroskop dengan pembesaran 1.000 kali, kemudian dibandingkan dengan hasil hitung trombosit dengan metode flowcytometry. Data kemudian dilakukan uji statistik dengan menggunakan uji One-Way ANOVA dilanjutkan dengan uji post-hoc. Data dianalisis menggunakan SPSS versi 17 untuk Windows.

Hasil: Sebagian besar responden berjenis kelamin perempuan (55,56%) dan memiliki rerata usia 42,37±20,90 tahun. Dari uji One-Way ANOVA ditemukan tidak terdapat perbedaan hitung trombosit diantara kelompok metode perhitungan yang digunakan (p=1,000). Uji post-hoc juga menunjukkan terdapat kesesuaian hasil perhitungan alat otomatis metode flowcytometry dengan metode hapusan darah tepi dengan pewarnaan dan tanpa pewarnaan dengan (p>0,05).

Kesimpulan. Terdapat kesesuaian antara metode hitung trombosit tanpa pewarnaan, dengan pewarnaan dan dengan hitung otomatis metode flowcytometry.

Analisis dampak trauma Kekerasan Dalam Rumah Tangga (KDRT) terhadap kecerdasan emosional anak di Desa Beraban, Tabanan, Bali

Background: Domestic violence is significantly affecting children's growth and development. To recover their physical and mental, they need optimal and psychological and educational treatments continuously, but nobody can guarantee that they will be improved well after therapy. This study aims to describe the interpretation of domestic violence towards emotional intelligence in children.

Methods: This quantitative research uses a retrospective descriptive study with a cross sectional study design, and the sampling technique is proportional stratified random sampling. Data were analyzed using SPSS version 17 for Windows.

Results: The results showed that most forms of domestic violence were in the form of mild physical violence (93.9%), mild psychological violence (87.8%), mild sexual violence (83.7%), and mild neglect (93.9%). Based on emotional intelligence, most respondents have high self-awareness (93.9%), high emotional management (98.0%), high self-motivation (95.9%), high empathy (95.9%), and social skills. high (95.9%). There is a significant relationship between domestic violence (KDRT) and emotional intelligence (KE) in children (p <0.05).

Conclusion: Domestic violence has a significant effect on children's emotional intelligence in Beraban Village, Bali, Indonesia.

Latar Belakang: Kekerasan Dalam Rumah-Tangga (KDRT) sangat mempengaruhi pertumbuhan dan perkembangan seorang anak. Dibutuhkan penanganan psikologis dan edukatif secara optimal dan berkesinambungan, untuk pemulihan fisik dan mental mereka, meskipun tidak ada suatu jaminan bahwa kondisi mereka akan sepenuhnya pulih setelah menjalani proses terapi. Penelitian ini bertujuan untuk dapat menggambarkan serta menginterpretasikan pengaruh KDRT terhadap kecerdasan emosional pada anak.

Metode: Penelitian kuantitatif ini menggunakan pendekatan deskriptif retrospektif dengan desain penelitian potong lintang (cross sectional) dan teknik pengambilan sampel secara proportionate stratified random sampling. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian menunjukkan bahwa sebagian besar bentuk KDRT dalam bentuk kekerasan fisik ringan (93,9%), kekerasan psikis ringan (87,8%), kekerasan seksual ringan (83,7%), dan penelantaran ringan (93,9%). Berdasarkan kecerdasan emosional, sebagian besar responden memiliki kesadaran diri tinggi (93,9%), pengelolaan emosi tinggi (98,0%), motivasi diri tinggi (95,9%), empati tinggi (95,9%), dan keterampilan sosial tinggi (95,9%). Terdapat hubungan yg bermakna antara kekerasan dalam rumah tangga (KDRT) dan kecerdasan emosional (KE) anak (p<0,05).

Kesimpulan: Kekerasan dalam rumah tangga memiliki pengaruh yang bermakna terhadap kecerdasan emosional anak di Desa Beraban, Bali, Indonesia.

Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia

Background: Amputation is a management that is needed in cases of diabetic foot but is still challenging to predict. In diabetic foot infections, there can be a disturbance in the balance of inflammatory mediators as a cause of tissue damage. Inflammation is assessed by the Neutrophil Lymphocyte Ratio (NLR), and the HbA1c value is associated with an increased risk of amputation. Wagner's classification describes the extent and weight of diabetic foot ulcers.

Methods: This study is a predictive diagnostic test on diabetic foot patients who meet the inclusion criteria. Consecutive sampling was conducted from medical records of Sanglah Hospital Denpasar patients from 2017 to 2019. NLR and HbA1c records were taken from the examination before receiving the medical intervention. An analysis using a 2x2 table is used to determine sensitivity and specificity, and a ROC curve analysis to determine the cut-off point with the best sensitivity and specificity. Data were analyzed using SPSS version 20 for Windows.

Results: A total of 82 patients met the inclusion criteria with an average age of 57 (46-69) years. There was 43 (52.4%) male and 39 (47.6%) females enrolled in this study. Most diabetic foot samples with Wagner III degree 35 (42.7%) and Wagner IV 34 (41.5%). A total of 31 (37.8%) patients underwent amputation. The ROC analysis showed an NLR cut-off point of 13.67 (AUC=0.617; p=0.078) with a sensitivity of 54.8% and specificity of 66.7%. ROC HbA1c analysis showed a cut-off point of 9.5% (AUC=0.455) with a sensitivity of 45.2% and specificity of 47.1%. Secondary data and operating reliability are limitations in this study, and it makes a lower sensitivity.

Conclusion: The results of this study indicate that the Neutrophil-Lymphocyte Ratio (RNL) and the HbA1c value can be used as predictors of amputation in diabetic foot patients at Sanglah General Hospital, Bali, Indonesia.

Latar Belakang: Amputasi merupakan penatalaksanaan yang diperlukan pada kasus kaki diabetik, namun masih sulit untuk diprediksi. Pada infeksi kaki diabetik dapat terjadi gangguan keseimbangan mediator inflamasi sebagai penyebab kerusakan jaringan. Inflamasi dinilai dari Rasio Neutrofil Limfosit (RNL) dan nilai HbA1c dihubungkan dengan meningkatnya resiko amputasi. Klasifikasi Wagner menggambarkan derajat luas dan berat ulkus kaki diabetik.

Metode: Penelitian ini adalah uji diagnostik prediktif pada pasien kaki diabetik yang memenuhi kriteria inklusi. Pengambilan sampel dari rekam medis pasien RSUP Sanglah Denpasar secara konsekutif dari tahun 2017 sampai 2019. Pencatatan NLR dan HbA1c diambil dari pemeriksaan sebelum mendapatkan intervensi medis. Kemudian dilakukan analisa menggunakan tabel 2x2 untuk menentukan sensitivitas dan spesifisitas, serta analisa kurva ROC untuk menentukan cut-off point dengan sensitivitas dan spesifisitas terbaik. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Sebanyak 82 pasien memenuhi kriteria inklusi dengan rata-rata umur 57 (46-69) tahun. Terdapat 43 (52,4%) laki-laki dan 39 (47,6%) perempuan dalam penelitian ini. Sebagian besar sampel kaki diabetik dengan derajat wagner III 35 (42,7%) dan wagner IV 34 (41,5%). Sebanyak 31 (37,8%) pasien menjalani amputasi. Dari analisa ROC menunjukkan cut-off point RNL sebesar 13,67 (AUC=0,617; p=0,078) dengan sensitivitas 54,8% dan spesifisitas 66,7%. Analisa ROC HbA1c menunjukkan cut-off point sebesar 9,5% (AUC=0,455) dengan sensitivitas 45,2% dan spesifisitas 47,1%. Data sekunder dan reliabilitas operasi menjadi keterbatasan dalam penelitian ini, sehingga sensitivitasnya rendah

Kesimpulan: Hasil penelitian ini menunjukkan bahwa Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c dapat dipergunakan sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia

Hubungan antara Microvessel Density dan Lymphovascular Invasion dengan metastasis jauh pada pasien kanker payudara di RSUP Sanglah, Bali, Indonesia

Background: Breast cancer is the most common malignant tumor in Indonesia, with a relative frequency of 18,6%. Mortality in breast cancer most are caused by distant metastasis, which then causes multiple organ failure. To start a metastatic process requires new blood vessels (angiogenesis) and infiltration of the lymphatic system. Both can be assessed through microvessel density and lymphovascular invasion. This study aims to determine the relationship between Microvessel Density and Lymphovascular Invasion with metastasis in breast cancer patients at Sanglah General Hospital, Bali, Indonesia.
Methods: A cross-sectional analytic study was conducted at the oncology surgical clinic from January 2018 - March 2019. Of the 62 biopsy samples were stained using hematoxylin-eosin and were observed by one pathologist. MVD cut-off points are taken by calculating the mean and standard deviation. Bivariate analysis using Chi-Square Test and multivariate analysis using logistic regression test was used for statistical analysis. Data were analyzed using SPSS version 23 for Windows.
Results: From the results of a bivariate analysis, it was found that the high MVD is correlated with distant metastasis (P = 0.001) and positive LVI with metastasis (P = 0.003). There is a relationship between high MVD and tumor size (P = 0,000).
Conclusion: Multivariate analysis confirmed that high MVD and positive LVI were statistically related to the occurrence of metastasis in breast cancer patients.

Latar Belakang: Kanker payudara merupakan salah satu jenis kanker terbanyak di Indonesia dengan frekuensi relatif sebesar 18,6%. Kematian pada kanker payudara sebagian besar disebabkan oleh metastasis jauh yang kemudian menyebabkan kegagalan organ multipel. Untuk memulai suatu proses metastasis diperlukan pembentukan pembuluh darah baru (angiogenesis) dan juga infiltrasi sistem limfatik. Kedua hal tersebut bisa dinilai melalui microvessel density dan lymphovascular invasion. Penelitian ini bertujuan untuk mengetahui hubungan antara Microvessel Density dan Lymphovascular Invasion dengan metastasis jauh pada pasien kanker payudara di RSUP Sanglah, Bali, Indonesia.
Metode: Penelitian potong lintang analitik dilakukan pada poliklinik bedah onkologi selama Januari 2018–Maret 2019. Dari 62 sampel biopsi dilakukan pembacaan microvessel dan lymphovascular invasion yang telah lebih dulu diberikan pewarnaan hematoxylin eosin oleh 1 patologi anatomi. Cut off point MVD diambil dengan cara menghitung mean dan standar deviasi. Analisis bivariat dengan Uji Chi-Square dan analisis multivariat dengan menggunakan uji regresi logistik digunakan untuk analisis statistik. Data dianalisis dengan SPSS versi 23 untuk Windows.
Hasil:  Dari hasil analisis bivariat didapatkan hubungan antara MVD yg tinggi dengan metastasis (P = 0,001) dan hubungan antara LVI positif dengan metastasis (P = 0,003). Terdapat hubungan antara MVD dengan ukuran tumor (P = 0,000).
Simpulan: Analisis multivariat menegaskan bahwa MVD yang tinggi dan LVI positif berhubungan secara statistik dengan terjadinya metastasis pada pasien kanker payudara.

Hubungan antara status nutrisi dan kualitas hidup pada pasien penyakit ginjal kronik yang menjalani hemodialisis di Rumah Sakit Umum Daerah (RSUD) Wangaya, Denpasar, Bali

Background: Quality of life is an important consideration in managing patients with chronic kidney disease (CKD). A number of factors are known to influence Quality of life in a patient with CKD, one of them is nutrition. In this study, we aimed to determine the relationship between nutritional status and Quality of life in CKD patients undergoing hemodialysis. 

Methods: A cross-sectional analytic study was conducted at Wangaya Regional Hospital, Denpasar, from August to September 2020. Fifty-seven hemodialysis patients were enrolled in this study. Malnutrition Inflammation Score (MIS) and Kidney Disease Quality of Life Short Form-36 (KDQoL SF-36) questionnaires were used to assess nutritional status and Quality of life. Data were analyzed using SPSS software version 20 for Windows, where a p-value of less than 0,05 was considered statistically significant.

Results: Of the total 57 subjects, the mean age was 50.12±13.1 years, with 68.4% male. The mean MIS score was 3.05±1.8, while the mean KDQoL score was 73.7±13.4. Pearson test found a significantly strong negative correlation between nutritional status and Quality of life (r=-0,784; p<0,001).

Conclusion: There is a significant relationship between nutritional status and Quality of life in chronic kidney disease patients undergoing hemodialysis in Wangaya Regional Hospital, Denpasar.

Latar Belakang: Kualitas hidup merupakan hal penting yang harus diperhatikan dalam menangani pasien penyakit ginjal kronik (PGK). Salah satu faktor yang memengaruhi kualitas hidup pasien PGK adalah nutrisi. Penelitian ini bertujuan untuk mengevaluasi hubungan antara status nutrisi dan kualitas hidup pada pasien PGK yang menjalani hemodialisis rutin.

Metode: Penelitian ini merupakan penelitian analitik observasional yang dilakukan di RSUD Wangaya Denpasar pada bulan Agustus-September 2020. Subjek penelitian adalah 67 pasien PGK yang menjalani hemodialisis rutin. Instrumen penelitian berupa kuesioner malnutrition inflammation score (MIS) dan kidney disease quality of life short form-36 (KDQoL SF-36). Data yang terkumpul selanjutnya dianalisis dengan menggunakan perangkat lunak SPSS versi 20 untuk Windows dimana nilai p<0,05 dianggap signifikan secara statistik.

Hasil: Rerata usia subjek adalah 50,12±13,1 tahun, dengan 68,4% subjek berjenis kelamin laki-laki. Rerata skor MIS subjek adalah 3,05±1,8, sedangkan rerata skor KDQoL adalah 73,7±13,4. Uji korelasi pearson menunjukkan korelasi negatif kuat antara skor MIS dan skor KDQoL (nilai r=-0,784 dan nilai p<0,001).  

Simpulan: Terdapat hubungan yang signifikan antara status nutrisi dan kualitas hidup pada pasien penyakit ginjal kronik yang menjalani hemodialisis rutin di RSUD Wangaya, Denpasar.

Hubungan antara platelet lymphocyte ratio (PLR) dengan subtipe kanker payudara pada pasien kanker payudara di Rumah Sakit Umum Pusat Sanglah, Denpasar

Background: Breast cancer is one of the most diagnosed malignancies, as well as the leading cause of cancer mortality in women worldwide. The research objective was to analyze the relationship between PLR and breast cancer subtypes in breast cancer patients in Bali.
Methods: This study used a cross sectional design to assess how PLR could predict cancer subtypes in breast cancer patients involving 52 respondents by consecutive sampling.
Result: age ? 51 years is the most respondents, 69.7% with p-value 0.218. The location of the left breast tumor was found to be more than 63.2% with a p-value of 0.416. The best cut-off point lies at 162.1. PLR ? 162.1 with the luminal subtype of breast cancer, there were 22 respondents 66.7% with an OR of 4.3 (CI: 1.29-14.50) and a p-value of 0.015. The results of logistic regression analysis showed that PLR is the dominant factor causing the luminal subtype of breast cancer.
Conclusion: Age and location of the tumor were not associated with breast cancer subtypes. PLR was significantly positive, and the strength of the association was moderate with the non-luminal subtype of breast cancer. PLR values tended to be higher in non-luminal cancer subtypes compared to luminal cancer subtypes. PLR has a dominant effect on the age and location of the tumor on the non-luminal subtype of breast cancer.

Latar Belakang: Kanker payudara adalah salah satu keganasan yang paling banyak didiagnosis, serta penyebab mortalitas akibat kanker terbanyak pada wanita di seluruh dunia. Tujuan penelitian untuk menganalisis hubungan PLR dengan subtipe kanker payudara pada penderita kanker payudara di bali.

Metode: Penelitian ini menggunakan rancangan cross sectional untuk menilai bagaimana PLR dapat memprediksi subtipe kanker pada pasien kanker payudara yang melibatkan 52 responden secara consecutive sampling.
Hasil: umur ? 51 tahun merupakan responden terbanyak (69,7%) dengan p-value 0,218. lokasi tumor mammae kiri didapatkan lebih banyak (63,2%) dengan p-value 0,416. Cutt off point terbaik terletak pada angka 162,1. PLR ? 162,1 dengan subtipe luminal kanker payudara didapatkan sebanyak 22 responden (66,7%) dengan OR 4,3 (IK: 1,29-14,50) dan p-value 0,015. Hasil analisis regresi logistik didapatkan PLR merupakan faktor dominan yang menyebabkan subtipe luminal kanker payudara.
Kesimpulan: Umur dan lokasi tumor tidak berhubungan dengan subtipe kanker payudara. PLR berhubungan positif secara signifikan dan kekuatan hubungan moderate dengan subtipe non luminal kanker payudara. Nilai PLR cenderung tinggi didapatkan pada subtipe kanker non luminal dibandingkan dengan subtipe kanker luminal. PLR mempunyai pengaruh dominan dibandingkan dengan umur dan lokasi tumor terhadap subtipe non luminal kanker payudara.

Characteristics retinometry pre and post cataract surgery on senile cataract patients in Sanglah Hospital, Bali-Indonesia

Background: WHO, with program Vision 2020-the Right to Sight, has a responsibility to control the most cause of blindness, which is a cataract. General-purpose of this research is to identify the retinometry pre and post cataract surgery on senile cataract patients.

Method: This study design is an analytical cross sectional study. All data were collected retrospectively from the medical report of retinometry of pre and post cataract surgery in Sanglah General Hospital.

Results: A total number of 60 eyes from 59 patients were included in this study. The majority of the patients were male (63.3%), aged 61-70, and came from Denpasar District (38.3%). The grading of cataract (Burrato) in this study is Burrato III (60%). A nuclear cataract is common in this study (41.7%). There were relationships between the differences of retinometry post dan pre cataract surgery with the grading of cataract (Burrato) (p<0.05), but there is no relationship with the type of cataract (p>0.05).

Conclusions: There is a significant difference between retinometry pre and post cataract surgery, no significant difference between retinometry post-cataract surgery with BCVA and type of cataract. Higher grades of cataract (Burrato V) significantly correlate with higher retinometry pre and post-cataract surgery.

Sistem skoring hematologi Rodwell sebagai metode diagnosis awal sepsis neonatorum di Rumah Sakit dengan fasilitas terbatas: sebuah tinjauan sistematis

Background: Neonatal sepsis is a major cause of morbidity and mortality in neonates with an incidence in Indonesia at about 8.7 to 30.29%. Blood culture as the gold standard for diagnosis is not available in all health care centers. An easy, fast and inexpensive diagnostic method is needed to overcome these problems. The diagnostic method that can be used is the Rodwell hematology scoring system (HSS). It uses seven hematologic parameters obtained through a complete blood count and peripheral blood smears examination. This systematic review aims to evaluate Rodwell HSS as a method for early diagnosis of neonatal sepsis in hospitals with limited facilities.

Methods: A systematic review of literature searching through the Cochrane Library, PubMed, and Google Scholar journal database was done by two reviewers. The inclusion criteria were studied about the diagnostic method for neonate's sepsis using Rodwell HSS and compared neonate's sepsis diagnostic method between Rodwell HSS and blood culture. The exclusion criteria were studies that were not published in English or Bahasa, not available in full text, and study with a case report, systematic review, or meta-analysis design.

Result: The hematological scoring system has the same sensitivity as its specificity. Sensitivity range is 80-100%, specificity 60.3-90%, PPV 26-73% and NPV 92.1-100%. A score of > 4 has an AUC value of 90.2%, which shows that this diagnostic test's accuracy is excellent.

Conclusion: The hematological scoring system with a score of > 4 gives the most rational and reliable results for the early diagnosis of neonatal sepsis. Due to its high sensitivity, specificity, and using simple examination, making these criteria suitable to use as a method for early diagnosis of neonatal sepsis, especially in limited health facilities hospital.

Latar belakang: Sepsis neonatorum merupakan penyebab utama morbiditas dan mortalitas pada neonatus dengan angka prevalensi di Indonesia 8,7 hingga 30,29%. Pemeriksaan baku emas untuk penegakkan diagnosis yaitu kultur darah, tidak tersedia di seluruh sentra layanan kesehatan. Sebuah metode diagnostik yang mudah, cepat dan murah diperlukan untuk mengatasi permasalahan tersebut yakni dengan sistem skoring hematologi (SSH) Rodwell. Tujuan tinjauan sistematis ini adalah mengevaluasi peran SSH Rodwell sebagai metode diagnosis dini sepsis neonatorum di rumah sakit dengan fasilitas terbatas.

Metode: Tinjauan sistematis berupa penelusuran literatur dilakukan oleh dua orang peneliti melalui database jurnal Cochrane Library, PubMed dan Google Scholar menggunakan operator Boolean. Kriteria inklusinya adalah studi mengenai metode diagnosis sepsis pada neonatus menggunakan SSH Rodwell dan membandingkan antara SSH Rodwell dengan kultur darah. Sedangkan kriteria eksklusinya studi yang terpublikasi tidak dalam bahasa Inggris atau Indonesia, tidak tersedia secara full-text dan desain studi berupa laporan kasus, tinjauan sistematis atau meta analisis.

Hasil: SSH Rodwell memiliki sensitivitas yang sama baiknya dengan spesifitasnya. Sensitivitas berada dalam rentang 80-100%, spesifisitas 60,3-90%, PPV 26-73% dan NPV 92,1-100%. Skor >4 memberikan nilai AUC 90,2% menunjukkan akurasi test diagnostik ini sangat baik.

Kesimpulan. SSH Rodwell dengan skor >4 memberikan hasil yang paling rasional dan reliabel untuk diagnosis awal sepsis pada neonatus. Penggunaan parameter yang sederhana menjadikan pemeriksaan ini cocok diaplikasikan pada rumah sakit dengan fasilitas kesehatan terbatas.

Koagulopati pada Coronavirus Disease-2019 (COVID-19): Tinjauan pustaka

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 has spread globally and become a new pandemic. Although the clinical manifestation of COVID-19 mainly affected the respiratory system, coagulopathy often occurs in the severe cases and is associated with increased mortality. This literature review aims to provide a review of coagulopathy in COVID-19.

Methods: This literature review involved 52 relevant literature about coagulopathy and COVID-19. Different data sources or manual literature search methods used to find articles related to the topic of literature.

Results: COVID-19 can trigger cytokine storms and systemic hyperinflammation which cause increased activation of coagulation and resulting in hypercoagulability. Hypercoagulability state in COVID-19 increases the risk of thrombosis and thromboembolism, particularly venous thromboembolism. Prophylactic anticoagulants can prevent thromboembolic events and improve the prognosis of COVID-19 patients with coagulopathy.

Conclusion: The hypercoagulation state in COVID-19 can increase the risk of complications from thrombosis and thromboembolism, especially venous thromboembolism. Increased D-dimers are a marker of coagulopathy that is often found in patients with severe COVID-19 and is associated with disease severity.

Latar Belakang: Coronavirus disease 2019 (COVID-19) merupakan penyakit infeksi akibat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 telah menyebar secara global dan menjadi pandemi baru. Walaupun manifestasi klinis COVID-19 terutama mengenai sistem respirasi, koagulopati seringkali terjadi pada kasus berat dan berhubungan dengan peningkatan mortalitas. Tinjauan pustaka ini bertujuan untuk memberikan ulasan mengenai koagulopati pada COVID-19.

Metode: Tinjauan pustaka ini melibatkan 52 literatur yang relevan tentang koagulopati dan COVID-19. Sumber data yang berbeda atau metode pencarian literatur manual digunakan untuk mencari artikel yang berkaitan dengan topik literatur.

Hasil: COVID-19 dapat memicu terjadinya badai sitokin dan hiperinflamasi sistemik yang menyebabkan terjadinya peningkatan aktivasi koagulasi dan mengakibatkan hiperkoagulasi. Keadaan hiperkoagulasi pada COVID-19 meningkatkan risiko terjadinya trombosis dan tromboemboli, terutama tromboemboli vena. Antikoagulan profilaksis dapat mencegah kejadian tromboemboli dan meningkatkan prognosis pada pasien COVID-19 dengan koagulopati.

Kesimpulan: Keadaan hiperkoagulasi pada COVID-19 dapat meningkatkan risiko terjadinya komplikasi trombosis dan tromboemboli, terutama tromboemboli vena. Peningkatan D-dimer merupakan penanda koagulopati yang sering ditemukan pada pasien COVID-19 berat dan berhubungan dengan keparahan penyakit.

Manifestasi klinis dan penanganan demam berdarah dengue grade 1: sebuah tinjauan pustaka

Introduction: Dengue Hemorrhagic Fever (DHF) is a disease caused by the Dengue virus from the Flavivirus genus, Flaviviridae family, with four serotypes (DEN-1. DEN-2, DEN-3, and DEN-4). Primary dengue fever Grade 1 should receive serious attention by monitoring the patient's clinical manifestations so that patients get the right therapy immediately. If it is not treated quickly and adequately, the patient can experience an emergency with signs of shock and cause death.

Method: The writing methodology used is a literature review. The literature source consists of relevant journals and books from the search engines PubMed, Google Scholar, and Proquest.

Results: Dengue virus infection can be asymptomatic and symptomatic. Symptomatic dengue virus infection generally has a clinical spectrum grouped into 3, namely undifferentiated fever, dengue fever, and dengue hemorrhagic fever. Dengue fever (DD) patients who have no comorbidities and social indications can be treated as outpatients. Patients are given symptomatic treatment in the form of antipyretics such as paracetamol at a dose of 10-15 mg/kg/body weight, repeated 4-6 hours if fever. The management of dengue hemorrhagic fever (DHF) is symptomatic and supportive. Supportive therapy in the form of fluid replacement, which is the main point in managing DHF.

Conclusion: In patients with dengue hemorrhagic fever grade I, close monitoring is needed regarding their clinical condition. This is because grade 1 dengue has the potential to be a more critical clinical condition. Early treatment will determine a better outcome.

 

 

Pendahuluan: Demam Berdarah (DB) disebabkan oleh vírus Dengue (genus Flavivirus), dengan empat serotipe utama, yaitu DEN1. DEN2, DEN3 dan DEN4. Penyakit DB utamannya Demam berdarah dengue (DBD) Grade 1 harus mendapat perhatian serius, salah satunya dengan melakukan monitoring manifestasi klinis pasien agar pasien mendapatkan terapi yang tepat dengan segera. Apabila tidak diatasi dengan tepat dan cepat pasien dapat mengalami kegawatan dengan tanda-tanda syok dan dapat menyebabkan kematian. Tinjauan Pustaka ini bertujuan untuk memberikan informasi terbaru mengenai tanda-tanda klinis DBD grade 1 agar praktisi dapat memberikan penanganan terbaik sebelum jatuh pada kondisi kritis

Metode: Dalam penulisan ini digunakan metode tinjauan pustaka. Sumber bacaan berasal jurnal-jurnal dan buku-buku yang relevan dan sesuai dari PubMed dan Google Scholar.

Hasil: Manifestai klinis DB dapat tidak bergejala (asimtomatik) dan bergejala simtomatik. Pasien dengan gejala dengue secara umum memiliki tiga jenis spektrum klinis yaitu demam yang tidak terdiferensiasi, demam dengue, dan demam berdarah dengue.. Pasien demam dengue (DD) yang tidak memiliki komorbiditas dan indikasi sosial dapat diperlakukan sebagai pasien rawat jalan. Pasien diberikan pengobatan simptomatik berupa anitpiretik seperti parasetamol dengan dosis 10-15 mg/kg/BB/dosis, diulang 4-6 jam bila demam. Tatalaksana demam berdarah dengue (DBD) diberikan secara simtomatis (sesuai gejala) dan suportif. Penanganan suportif dapat diberikan berupa cairan tambahan yang merupakan poin utama dalam penatatalaksanaan DBD.

Kesimpulan: Pada pasien demam berdarah dengue derajat I diperlukan pemantauan yang ketat terkait kondisi klinis pasien. Hal ini dikarenakan DBD grade 1 berpontensi menjadi kondisi klinis yang lebih kritis. Penanganan dini akan menentukan outcome yang lebih baik.

Comparison between negative pressure and conventional wound dressing for diabetic foot ulcer: A systematic review

Background: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus (DM), resulting in loss of limb or life. Negative pressure wound therapy (NPWT) is an emerging therapeutic option in the management of DFU. This study aims to compare the efficacy of NPWT to conventional moist wound dressing in the management of DFU.

Methods: Literature was searched from online public scientific databases, including PubMed, Google Scholar, ScienceDirect, and Portal Garuda. Our review included clinical trials and analytic studies comparing NPWT and conventional moist dressing to treat DFU published in 2017 or later. Outcome measures include the proportion of wound healing, healing time, ulcer size reduction, granulation time, amputation, infection, and bleeding.

Results: We include 11 articles, including eight randomized clinical trials (RCTs), two retrospective analytic studies, and one non-random clinical trial. There was methodological variation between studies on the application of NPWT, outcome measures reported, and length of follow up. Results mostly showed NPWT yielded a higher proportion of complete wound healing, shorter healing time, granulation time, and faster ulcer size reduction rate. However, NPWT was not associated with a reduction of amputation risks.

Conclusions: Our review found NPWT was superior in short-term treatment outcomes such as granulation time and wound closure; however, there was no difference in reducing amputation risk between NPWT and conventional moist dressing. Results are inconclusive due to variation in methodologies of included articles.

Kenpaullone (CDK2 Inhibitor dan GSK-3? Inhibitor) sebagai agen otoprotektif pada pasien kemoterapi berbasis cisplatin: tinjauan pustaka

Background: Malignancies are one of the diseases with the most sufferers, almost all country in the world has a number of these diseases. Cisplatin-based chemotherapy regimens have long been the gold standard in the treatment of various soft tissue malignancies. Despite many beneficial cisplatin features, it also has serious side effects, which are nephrotoxicity, neurotoxicity, and ototoxicity. This literature study aims to theoretically review the role of kenpaullone (CDK2 Inhibitor and GSK-3? Inhibitor) as an autoprotective agent in cisplatin-based chemotherapy patients.

Methods: The literature review approach is used in this study. Sources of reading come from relevant and appropriate journals and books from PubMed and Google Scholar.

Results: Cisplatin is thought to selectively damages the outer hair cells within the organ of Corti, spiral ganglion cells, and cells within the stria vascularis. It is reducing the formation of free radicals as otoprotective strategies by maintaining glutathione levels and antioxidant activity. Kenpaullone provided significant protection against cisplatin-induced ototoxicity when delivered by tran tympanic injection in zebrafish, mice, and rats. Kenpaullone has proven to directly inhibit cyclin-dependent kinase 2 (CDK2) and Glycogen synthesis kinase-3, thereby attenuating cisplatin-induced mitochondrial ROS production caspase 3/7-mediated cell death. Cisplatin can cause ototoxicity in the manifestation of hearing loss; thus, an otoprotector is needed to prevent this side effect. Kenpaullone is a CDK2 inhibitor and GSK-3 inhibitor that can reduce damage to outer hair cells induced by cisplatin to prevent ototoxic hearing loss.

Conclusion: The results of this study indicate that various literature studies show that kenpaullone (CDK2 Inhibitor and GSK-3? Inhibitor) can be used as an autoprotective agent in cisplatin-based chemotherapy patients.

Latar Belakang: Keganasan merupakan salah satu penyakit yang memiliki jumlah pasien terbanyak, hampir seluruh negara di dunia memiliki jumlah penderita penyakit tersebut. Kemoterapi berbasis cisplatin telah lama menjadi baku emas untuk terapi pada beberapa keganasan jaringan lunak. Selain memberikan banyak keuntungan, cisplatin juga menimbulkan efek samping yang berat seperti nefrotoksik, neurotoksik, dan ototoksik. Studi tinjauan pustaka ini bertujuan untuk meninjau secara teoritis peran kenpaullone (CDK2 Inhibitor dan GSK-3? Inhibitor) sebagai agen otoprotektif pada pasien kemoterapi berbasis cisplatin.

Metode: Dalam penulisan ini digunakan metode tinjauan pustaka. Sumber bacaan berasal jurnal-jurnal dan buku-buku yang relevan dan sesuai dari PubMed maupun Google Scholar.

Hasil: Diduga bahwa cisplatin secara selektif merusak bagian sel luar disertai organ korti, sel ganglia spiral, dan sel dengan stria vaskularis. Strategi otoprotektif termasuk menurunkan pembentukan radikal bebas dengan menjaga level gluthione dan aktivitas antioksidan. Kenpaullone memberikan efek protektif signifikan terhadap ototoksisitas akibat terapi cisplatin ketika dinjeksikan secara transtimpani pada ikan zebra, dan tikus. Kenpaullone terbukti secara langsung menginhibisi Cyclin-Dependent Kinase 2 (CDK-2) dan Glycogen Synthesis Kinase-3 (GSK-3), menurukan produksi ROS mitokondria yang diinduksi oleh cisplatin serta caspase 3/7 yang memediasi kematian sel. Sehingga hal tersebut dapat mencegah terjadinya gangguan pendengaran akibat ototoksik.

Kesimpulan: Hasil tinjauan pustaka ini menunjukkan bahwa berbagai studi literatur menunjukkan bahwa kenpaullone (CDK2 Inhibitor dan GSK-3? Inhibitor) dapat dipergunakan sebagai agen otoprotektif pada pasien kemoterapi berbasis cisplatin.

Aspek klinis dan tatalaksana gagal jantung pada anak: tinjauan pustaka

Background: Heart failure in children is a serious health problem and associated with high morbidity and mortality. The causes and clinical manifestations of heart failure in children differ significantly with heart failure in adults. Therefore, a comprehensive understanding of heart failure in children is needed. This literature review aims to provide a review of clinical aspects and treatment of heart failure in children.

Methods: This literature review included 47 relevant literature on clinical aspects, management of heart failure, and children. Different data sources or manual literature studies were used to search for articles related to literature topics.

Results: The main causes of heart failure in children are congenital heart disease and cardiomyopathy. Diagnostic approach of heart failure in children is based on clinical features combined with supporting examination. The principal treatment of heart failure in children includes identification and elimination of precipitating factors, correction of underlying causes, and management of pulmonary or systemic congestion.

Conclusion: Heart failure is a complex clinical syndrome that results from structural or functional disorders of the filling or ejection of blood from the ventricles of the heart where the clinical manifestations and management of heart failure in children are specific.

Latar Belakang: Gagal jantung pada anak merupakan masalah kesehatan serius dan berhubungan dengan morbiditas dan mortalitas yang tinggi. Penyebab dan manifestasi klinis gagal jantung pada anak berbeda signifikan dengan gagal jantung pada orang dewasa. Oleh karena itu, dibutuhkan pemahaman komprehensif tentang gagal jantung pada anak. Tinjauan pustaka ini bertujuan untuk memberikan ulasan mengenai aspek klinis dan tatalaksana gagal jantung pada anak.

Metode: Tinjauan pustaka ini melibatkan 47 literatur yang relevan tentang aspek klinis, tatalaksana gagal jantung, dan anak. Sumber data yang berbeda atau metode pencarian literatur manual digunakan untuk mencari artikel yang berkaitan dengan topik literatur.

Results: Penyebab utama gagal jantung pada anak adalah penyakit jantung bawaan dan kardiomiopati. Pendekatan diagnosis gagal jantung pada anak berdasarkan gambaran klinis yang dikombinasikan dengan pemeriksaan penunjang. Prinsip tatalaksana gagal jantung pada anak meliputi identifikasi dan eliminasi faktor presipitasi, koreksi penyebab yang mendasari, serta penanganan kongesti pulmonal atau sistemik.

Kesimpulan: Gagal jantung adalah suatu sindrom klinis kompleks yang terjadi akibat gangguan struktural atau fungsional dari pengisian atau ejeksi darah dari ventrikel jantung dimana manifestasi klinis dan tatalaksana gagal jantung pada anak bersifat khusus.

Positive calretinin stain with immunohistochemistry in a 49 year-old female with cardiac myxoma: A case report

Background: Primary tumors of the heart are scarce. Cardiac myxoma is a primary benign heart tumor most often found with an incidence of 0.5-1.0 cases per million population per year and 90% diagnosed in the fourth to seventh decades of life, rarely found in children. Cardiac myxoma is three times more common in women than in men. These tumors are mostly found in the left atrium.

Case description: Female, a 49-year-old patient, came with palpitations, shortness of breath, and weakness since the previous six months. On echocardiography, found a mass in the left atrium suspected of a left atrial myxoma. Surgery was performed, and the specimen was sent for histopathological examination. Macroscopically, the tumor mass shows an irregular shape, brownish color, and spongy consistency. Microscopic examination shows the tumor consisting of proliferation of spindle-shaped and stellate cells, with oval to round nuclei, eosinophilic cytoplasm, mostly scattered, some of which are arranged cord and nest, infiltrative between the myxoid stroma and partially surround small blood vessels to form a vasoformative ring. The specimen also contains the proliferation of blood vessels, extravasation of erythrocytes, and the distribution of inflammatory cells and hemosiderophages. The result of the immunohistochemical examination with calretinin was positive.

Conclusion: This case was concluded as cardiac myxoma based on clinical features, echocardiography, macroscopic, routine histopathological, and immunohistochemical examinations.

Pencitraan pada pankreolithiasis dengan pankreatitis kronis: laporan kasus

Background: Pancreolithiasis or pancreatic calculus is a rare case. Men suffer more than women with a ratio of 2-3:1 and have an incidence of 1-8:100.000. Pancretolithiasis itself is a sequela of chronic pancreatitis. Accompanied by non-specific complaints, epigastric abdominal pain that radiates to the back to the left shoulder and nausea, vomiting which causes weight loss and malnutrition. Radiological examination can help the clinician in. establish a diagnosis where the laboratory results are also not specific enough to diagnose chronic pancreatitis. The aim of this report is to determine the radiological features of pancreolithiasis accompanied by chronic pancreatitis.

Case: A 54-year-old woman with complaints of pain in the epigastric region for approximately 3 months, accompanied by nausea and vomiting, especially after eating which resulted in weight loss of approximately 10 kilograms. In laboratory tests, an increase in total cholesterol, LDH and hyperkalemia was found. There is no increase in amylase and lipase and hepatic function. On plain abdominal radiograph, ultrasound and CT scan, it is found that there is a stone image accompanied by imaging of chronic pancreatitis.

Conclusion: Pancreatic calculus is a rare condition. More common in male gender, patients with pancreolithiasis have non-specific discharge. Alcohol use is said to be the biggest factor in pancreolithiasis. On plain abdominal radiograph, ultrasound and CT scan can reveal the presence of stones in the pancreas and the presence or absence of involvement of the pancreatic parenchyma.

Keberhasilan Terapi Rituximab pada Seorang Pasien dengan Lupus Nephritis Berat: Laporan Kasus

Background: Lupus nephritis is one of complication of systemic lupus erythematosus (SLE) which manifests to the kidneys. Lupus nephritis occur in 50-60% of cases in the first ten years of the onset of SLE. Standard therapy for lupus nephritis are immunosuppressive drugs such as corticosteroids and cytostatics. In a refracter case, biologic agent has giving new hope.

Case description: We report a case of seventeen years old female with chief complaints of edema in both feet, skin rash caused by sun exposure, joint pain, mouth ulcer with positive ANA test, proteinuria and high blood sugar level. Patient was then diagnosed with SLE, lupus nephritis and other types of DM. Patient was treated with combination theraphy of cycloposphamide and Rituximab. Patient then discharged in good condition.

Conclusion:  we suggest that combination of cycloposphamide and Rituximab is effective in controlling SLE and reducing the dose of steroid theraphy.

Keyword: biological agents, systemic lupus erythematosus, lupus nephritis

Latar belakang: Lupus nephritis merupakan salah satu komplikasi penyakit Systemic Lupus Erythematosus (SLE) yang bermanifestasi ke ginjal. Komplikasi lupus nephritis terjadi pada 50-60% kasus dalam sepuluh tahun pertama onset penyakit SLE. Terapi lupus nephritis meliputi obat-obatan imunosupresif seperti kortikosteroid dan sitostatika. Pada kasus-kasus yang refrakter, terapi dengan agen biologis memberikan harapan baru. Harapan hidup jangka panjang dan renal survival pasien SLE dengan lupus nephritis secara progresif telah mengalami peningkatan sejak ditemukannya agen biologis, rujukan yang lebih dini, dan kriteria diagnostik yang lebih baik.

Deskripsi kasus:Kami melaporkan kasus seorang perempuan, berusia 17 tahun, suku Timor, datang dengan keluhan utama bengkak pada kedua punggung kaki, kemerahan pada kulit bila terkena sinar matahari, nyeri sendi, ulserasi pada mulut, dengan hasil laboratorium ANA test positif, proteinuria, disertai kadar gula darah yang tinggi. Pasien didiagnosis dengan SLE, lupus nephritis, dan DM Tipe lain. Setelah diberikan terapi cycloposphamide dan Rituximab, kondisi pasien membaik. Kesimpulan: regimen terapi ini efektif untuk mengontrol penyakit SLE dan memungkinkan untuk penurunan dosis terapi steroid.

Kesulitan diagnosis pada kasus fraktur kondilus lateral humerus pada anak di bawah umur dua tahun: laporan kasus

Background: The lateral humeral condylus fracture in a child can be difficult to diagnose because the bones of a child not ossification yet. This resulted the fracture is difficult to see or even pass in viewing. In management, the lateral humeral condylus fracture in children has controversy, between non-operative and operative (especially in fracture with minimal displace). This case report discusses the case of the humeral lateral condyle fracture in a two-year-old child and discusses its treatment.

Case: A two-years-old boy was delivered by his parents to the Emergency Room (ER) in the Wangaya Regional General Hospital Denpasar with complaints of pain in the left elbow since a day ago. Complaints appear after the patient falls on the floor in his home while playing with his brother. On physical examination of the upper extremity, the left elbow is swollen at the elbow with minimal deformity without an open wound. In manage it, open reduction surgery is performed by apply Kirschner-wire and then backslab is placed on the left arm with supination and 30^o flexion positions.

Conclusions: Difficulties in diagnosing humeral lateral condylus fractures in children are due to the fact that there are still many condyle plates that have not ossification yet, so that it is difficult for radiological examination to see the fracture line. The operative actions that can be taken are open reduction with the installation of Kirschner-wire.

Latar Belakang: Fraktur kondilus lateral humerus pada anak dapat sulit terdiagnosis akibat tulang anak yang belum terosifikasi. Hal ini mengakibatkan gambaran fraktur sulit terlihat atau bahkan terlewati. Dalam penatalaksanaanya, fraktur kondilus lateral humerus pada anak memiliki kontroversi, antara non-operatif dan operatif (terutama pada fraktur dengan pergeseran minimal). Laporan kasus ini bertujuan untuk membahas kasus fraktur kondilus lateral humerus pada anak umur dua tahun dan membahas tatalaksananya.

Kasus: Seorang anak laki-laki berumur dua tahun diantar oleh orangtuanya ke Unit Gawat Darurat (UGD) Rumah Sakit Umum Daerah Wangaya Denpasar dengan keluhan nyeri pada siku kiri sejak satu hari yang lalu. Keluhan muncul setelah pasien terjatuh di lantai rumah saat sedang bermain dengan saudaranya. Pada pemeriksaan fisik ekstremitas atas, pada siku kiri didapatkan bengkak pada siku dengan deformitas minimal tanpa disertai luka terbuka. Dalam penanganannya, dilakukan tindakan operasi reduksi terbuka dengan pemasangan Kirschner-wire kemudian dipasang backslab pada lengan kiri dengan posisi supinasi dan fleksi 30^o.

Simpulan: Dalam mendiagnosis fraktur kondilus lateral humerus pada anak diakibatkan masih banyak lempeng kondilus yang masih belum terosifikasi, sehingga pada pemeriksaan radiologis sulit melihat garis frakturnya. Tindakan operatif yang dapat dilakukan berupa reduksi terbuka dengan pemasangan Kirschner-wire.

Cholelithiasis and chronic cholecystitis in a ten-year-old-boy: a case report

Background: Cholelithiasis in children is uncommon and challenging to diagnose because the patient is often asymptomatic and the clinical feature doesn't clearly depict cholelithiasis or cholecystitis. This case study aims to describe a rare case of cholelithiasis with chronic cholecystitis in a ten-year-old boy.

Case Presentation: A ten-year-old boy presented with umbilical pain, nausea, and emesis. Physical examination showed there is no tenderness in all abdominal quadrants with a negative Murphy sign. Laboratory results revealed elevated white blood cell count 20.42x10³/?L, elevated erythrocyte sedimentation rate 47.2 mm/hour, normal liver function tests, urine, and stool analysis. He underwent transabdominal ultrasound twice. The latest transabdominal ultrasound showed cholelithiasis, free fluid around the pelvic region due to suspected visceral organ perforation. Laparoscopic cholecystectomy was performed without complication. The result of pathology anatomy examination was chronic cholecystitis. The patient was discharged 3 days after surgery in good condition. The long-term prognosis of the patient was good.

Conclusion: Even though the patient is male with good nutritional status (not obese), the patient was in the mean age that was identified as a key contributor to this disease. Ultrasonography examination is a screening modality that is still an excellent diagnostic tool with 95% accuracy even though it is highly operator dependent. Laparoscopic cholecystectomy is a gold standard for management even in children with decreased pain and shorter lengths of stay in the hospital.

Successful hiatal hernia repair with Nissen fundoplication by laparoscopic approach: a case report

Background: Hiatus hernias represent a herniation of viscera, most commonly the stomach, into the mediastinum through the esophageal hiatus of the diaphragm.There are two main classifications, sliding hernias and paraesophageal hernias. This case study aims to evaluate the successful hiatal hernia repair with Nissen fundoplication by a laparoscopic approach.

Case Presentation: We present a case of a 60-year-old male who presented with recurrent abdominal discomfort 6 months prior to the consultation. This was accompanied by loose stools, bloating, nausea, and vomiting. An initial diagnosis of Gastroesophageal Reflux Disease (GERD) was made. Conservative treatment was initiated with limited success. Endoscopy was then performed, revealing a hiatal hernia. Surgical intervention was then chosen as a therapeutic option via a laparoscopic approach and additional Nissen fundoplication with favorable outcomes.

Conclusion: Symptomatic paraesophageal hernias are indicated for surgical repair.Paraesophageal hernias can be repaired transthoracically and transabdominal. Repairs via the transabdominal route can be performed with an open approach or laparoscopically, with the laparoscopic approach suggesting lower mortality and morbidity. Nissen fundoplication has been proven as an effective measure in GERD's control and in maintaining an intra-abdominal location of the gastroesophageal junction (GEJ).

Lower Urinary Tract Obstruction (LUTO) pada fetus: laporan kasus

Background: Lower fetal urinary tract obstruction (LUTO) is an abnormality observed during an ultrasound test in the antenatal period in the form of an enlarged fetal bladder. Oligohydramnios, renal cortex dilation, and pulmonary hypoplasia may be caused by obstruction of the lower urinary tract. In the management of LUTO, early diagnosis and assessment as early as possible are very important. The insertion of a shunt from the fetal bladder to the amniotic cavity is one of the therapies for fetal LUTO (vesicoamniotic shunt). This case study aims to determine the management of LUTO in fetuses at Sanglah Hospital, Bali, Indonesia.

Case Presentation: A 39-year-old female G3P2002 was referred to the obstetrics and gynecology clinic of Sanglah Hospital with suspected fetal LUTO for 18-19 weeks. There were no complaints or risk factors for LUTO in the past. Physical examination and obstetric examinations were within normal limits. On ultrasound examination, there was a hypohyperechoic image measuring 4.3 x 5.3 cm with the impression of the enlarged bladder, key-hole appearance, oligohydramnios, and bilateral hydronephrosis. Double pigtail installation on the fetus, amnioinfusion, and amniosynthesis was performed for karyotyping. Ten weeks after double pigtail placement, the patient developed premature labor and subsequently gave birth to a baby boy, LBW 1,800 gram, with severe asphyxia, Potter facies, abdominal distension, and leg deformities. Unfortunately, the baby eventually died 1 hour postpartum.

Conclusion: Overall, infants have a poor prognosis for fetal LUTO cases. In assessing the effectiveness of treatment, early diagnosis, assessment, and early intervention are very critical.

Latar Belakang: Lower Urinary Tract Obstruction (LUTO) pada fetus merupakan suatu kelainan pada periode antenatal berupa pembesaran kandung kemih fetus yang ditemukan pada pemeriksaan USG. Sumbatan saluran kemih bagian bawah tersebut dapat menyebabkan oligohidramnios, pelebaran korteks ginjal, hingga hipoplasia paru. Diagnosis awal dan evaluasi sedini mungkin sangat penting dalam penanganan LUTO. Salah satu penanganan fetal LUTO adalah dengan pemasangan shunt dari vesika urinaria fetus ke rongga amnion (vesicoamniotic shunt). Laporan kasus ini bertujuan untuk mengevaluasi penanganan LUTO terhadap fetus di RSUP Sanglah, Bali, Indonesia

Presentasi Kasus: Seorang perempuan 39 tahun G3P2002 18-19 minggu dirujuk ke poliklinik kebidanan dan kandungan RS Sanglah dengan kecurigaan fetal LUTO. Pada anamnesis tidak didapatkan keluhan maupun faktor risiko LUTO. Pemeriksaan fisis dan pemeriksaan obstetri dalam batas normal. Pada pemeriksaan USG didapatkan gambaran hipohiperekoik berukuran 4,3 x 5,3 cm dengan kesan vesika urinaria membesar, key-hole appearance, oligohidramnios dan hidronefrosis bilateral. Dilakukan tindakan pemasangan double pigtail pada fetus, amnioinfusion serta amniosintesis untuk pemeriksaan karyotyping. Sepuluh minggu setelah pemasangan double pigtail, pasien mengalami partus prematurus imminens dan selanjutnya melahirkan bayi lelaki, BBL 1.800 gram, dengan asfiksia berat, Potter facies, distensi abdomen dan deformitas tungkai. Sayangnya, bayi akhirnya meninggal 1 jam pasca-persalinan.

Kesimpulan: Secara keseluruhan kasus fetal LUTO memiliki prognosis yang kurang baik bagi bayi. Diagnosis awal, evaluasi dan intervensi sedini mungkin sangat penting dalam menentukan keberhasilan terapi.

Exogenous Rinolith: a case report

Background: Rhinolith results from mineralized nasal foreign bodies. The time required for rhinolith formation is around 15 years and is usually diagnosed in the third decade of life. Most rhinoliths are asymptomatic or present with unspecific minimal symptoms. Symptoms of rhinolith include unilateral or bilateral foul nasal discharge, epistaxis, nasal obstruction, and halitosis. This case study aims to evaluate the recent management of exogenous rhinolith.

Case Presentation: We present a case of unilateral rhinolith in an 11 years old boy with a history of inserting eraser fragment into the left nostril at the age of 5. The patient complained of recurrent epistaxis with foul nasal discharge from the left nasal cavity. Rhinolith was extracted under general anesthesia. The extraction performed using raspatorium and headlight. The rhinolith was firmly attached to the floor of the nasal cavity but can be removed in toto. The specimen was sent to the Pathology Department for histopathological examination. The result showed respiratory epithelium covering edematous stroma with a proliferative vessel and lymphoplasmacytic inflammatory cell infiltration

Conclusion: Rhinolith is a rare condition with no or minimal symptoms. Management of rhinolith is extraction that can be performed under local or general anesthesia.

Staphylococcus aureus sebagai agen penyebab infeksi pada kasus erisipelas kruris dekstra dengan liken simpleks kronikus

Background: Erysipelas is a skin and soft tissue infection that affects the epidermis and superficial dermis as well as superficial lymphatic vessels. Erysipelas can occur due to the entry of bacteria through the skin barrier that is not intact and can occur in other medical conditions such as in patients with lichen simplex chronicus.

Case presentation: A man, aged 62, Javanese, came to the Sanglah Hospital Emergency Room because of swelling, redness, and pain in the right calf since 2 days ago and complained of itching in the right lower leg since 1 week ago. The patient has a 1-year history of lichen simplex chronicus and has received medication. Physical examination found the presence of erythema patch efflorescence, warm palpation of the touch, non-pitting edema, pain on pressure, and diascopy test of blanching on pressure. The results of the wound bed culture examination showed the isolation of S. aureus. Intravenous fluids, open compresses, antibiotics, pain relievers, and anti-inflammatory creams were given to patients who experienced improvement on day 8.

Discussion: The diagnosis of erysipelas is determined from the patient's complaints and the clinical picture from the results of the physical examination. In erysipelas, microbial pathogens enter through skin damage, then spread locally and systemically. Antibiotics have become the standard in the management of erysipelas by bacterial infections. The administration of ceftriaxone antibiotics was carried out based on the results of the sensitivity test also obtained on the results of the isolation of sensitive S. aureus bacteria.

Conclusion: Diagnosis of erysipelas is based on history, physical examination, and investigation. Management of patients includes open compresses, administration of fluids, antibiotics, pain relief, and use of anti-inflammatory creams.